Health Insurance 101
At Aspire Psychology, we fully understand health insurance details can be hard to navigate. Knowing how your insurance works can help you get the mental health care you need without unexpected costs. Our administrative and billing team will help you be in the know about your coverage!
Key Terms to Know
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.
Cost sharing is a way for you and your insurance company to share the costs of your healthcare. Once you’ve reached your out-of-pocket maximum, your health insurance usually covers 100% of your healthcare costs.
Think of you and your insurance company as partners working together to pay for your care. Everyone's plan is different, with varying deductible, copay, and coinsurance amounts. To help clarify these concepts, here are some examples to guide you.
Insurance Companies
At Aspire we see patients with a variety of insurances, both in and out of network. We are in network with Pacific Source, Aetna, Blue Cross Blue Shield and some Kaiser plans, but many patients with other insurances see our providers also.
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 provide superbills, detailed invoices of your therapy services, for you to submit to your out of network insurance for potential reimbursement.
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 Practice Administrator, Jamie Zimmerman, via email or by phone at 503.994.8811 ext 102.
