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Health Insurance 101

We at Aspire fully understand health insurance details can be difficult to navigate, and we try our best to provide the clearest and most accurate information possible to our patients. Health insurance can be complicated!

Key Terms to Know

In order to best understand what your insurance benefits are and what they mean, it’s important to be familiar with some key insurance terms and how they all work together to form your overall healthcare coverage.

Deductibles, copays and coinsurance make up your out-of-pocket costs. Out of pocket costs are what you are responsible for paying your providers. All of these fees combined contribute to your out-of-pocket maximum. Let’s break those terms down one by one.

Deductible: this is the amount you have to pay before insurance starts paying their portion to your providers.

Copay: this is a set amount you pay each time you see your provider after you have fully met your deductible.

Coinsurance: this is a percentage of the service you’re receiving from your provider that you are required to pay after your deductible is fully met.

*Sometimes you will have a copay or a coinsurance, occasionally you may have both

Out of pocket maximum: this is a cap on the amount of money you pay in copays, deductible and coinsurance during your insurance plan year.

These terms are all elements of what is called cost sharing. After this out of pocket maximum has been satisfied, your health insurer typically covers 100% of the cost of healthcare services.

Think of you and your insurance company as partners who work together to pay for your health care. Everyone’s plan will be different and deductible, copay, and coinsurance amounts differ depending on each particular insurance plan, but here are some examples of these terms to help you better understand their concepts.

Insurance Companies

At Aspire we see patients with a variety of insurances, both in and out of network.

If your insurance is out of network, this means our providers are not contracted with your insurance company. As a patient at Aspire Psychology you would be responsible for the full fee for services provided, which will be due at the end of your appointment. However, even if you’re out of network, you may have what are called out of network benefits. This means your insurance company may reimburse you a portion or percentage of that visit cost!

As a courtesy, we check your benefits and bill all insurance companies on your behalf.

The Aspire Patient Experience

Interested in becoming a new patient at Aspire Psychology? We keep things simple and streamlined for you, offering easy-to-complete online paperwork.

We look forward to welcoming you to Aspire, and to helping you receive quality, comprehensive care. If you have further general questions regarding health insurance or your particular plan details, don’t hesitate to reach out to our assistant office manager and insurance specialist Megan at 503.994.8811 ext 8 or megan@aspirepsychologyportland.com.

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