How do I understand using my insurance for therapy or nutrition counseling? What is my eligibility and benefits with my insurance plan?

Insurance language can sometimes be confusing. How do I navigate my insurance benefits? What is a copay? What is a deductible?

You might ask, “I want to start therapy services with Carmel Therapy Network. I don’t understand my insurance benefits, or using private pay, or being out of network. Where do I start?”

Understanding the costs and insurance coverage before starting therapy is essential. However, the use of jargon by both the insurance company and the therapy industry can make it confusing. It may take some effort to navigate and find a starting point. Typically on the back of your insurance card is a phone number you can call to ask about your benefits; we highly recommend this, as every plan can be different. If you are not in network with us, meaning your insurance company is not Anthem BCBS of Indiana, you can ask about your out-of-network (OON) benefits.

In-network & Credentialed

In-network & Credentialed: At Carmel Therapy Network, our group is credentialed with Anthem Blue Cross Blue Shield - Indiana. This means our Psychotherapists & Dietitians are in network with Anthem BCBS insurance. We are unable to accept HIP plans at this time.

Out-Of-Network Benefits

 Out-Of-Network Benefits: Out-of-network benefits refer to the coverage provided by an insurance company for healthcare services obtained from a healthcare provider that is not in the ins network of preferred providers. Understanding your out-of-network benefits before seeking healthcare services can help you to avoid unexpected medical bills.

Private Pay

Private Pay: Private pay for therapy refers to paying for therapy services out of pocket rather than through insurance or other third-party payment options. This can benefit individuals who do not have insurance coverage for therapy or prefer to keep their therapy sessions private. Private pay can also allow for more flexibility in scheduling and therapist choice. When clients can pay for treatment privately, there is some therapeutic freedom that comes with this, including increased confidentiality, as we do not involve the insurance company in your care; we are not limited by the insurance company’s requirements: diagnosis, treatment planning, ongoing assessments, or even “medically necessary” session times. These items are required by the insurance company for reimbursement.

Superbill

• We are happy to provide you with a weekly or monthly Superbill to submit to your insurance company for reimbursement. A superbill is a document that contains a detailed list of the services provided by a healthcare provider, along with the corresponding charges for each service. It is typically used by patients to submit claims to their insurance company for reimbursement. The superbill includes information such as the date of service, the type of service provided, the diagnosis code, and the charges for each service. It is important for patients to review their superbill carefully to ensure that all services listed were actually received and that the charges are accurate.

Deductible

• Deductible: A deductible is an amount of money you agree to pay out of pocket before your insurance coverage kicks in, although you still may have a copay or coinsurance dependent upon your plan. This number resets at the start of every year. For example, if you have a $1,000 deductible and get a service that costs $4,000, you will be responsible for paying the first $1,000, and your insurance company will cover the remaining $3,000. Deductibles can be found in various insurance policies, including health insurance, auto insurance, and homeowners insurance. The higher the deductible you choose, the lower your monthly premium payments will be, but the more you will be responsible for paying out of pocket if an incident occurs.

Co-pay

Co-pay: A copay is a fixed amount of money an individual pays out of pocket for a specific medical service. It is usually a set amount predetermined by the insurance plan and can vary depending on the type of service. Copays are designed to help share the cost of healthcare between the insurance provider and the individual. This flat fee is typically paid at the time of service. Copays are often used with deductibles and coinsurance to help individuals manage their healthcare costs.

Coinsurance

Coinsurance: Coinsurance is a term used in the insurance industry to describe the sharing of costs between the insurance company and the policyholder. Essentially, it refers to the percentage of the total cost of a covered service that the policyholder is responsible for paying. For example, if the coinsurance for therapy is 20%, the insurance company will pay 80% of the total cost, and the policyholder will be responsible for paying the remaining 20%. Coinsurance is often used in health insurance policies and can help keep premiums lower while providing coverage for necessary medical expenses.

Sliding Scale

 Sliding Scale: A sliding scale refers to a method of pricing or payment that varies based on certain factors such as income, usage, or need. The idea behind a sliding scale is to make a service accessible and affordable to people with different financial circumstances. For example, a healthcare provider may offer a sliding scale fee based on a patient's income level. This allows lower-income individuals to still receive quality healthcare without experiencing financial burdens. Sliding scales can also be used in other industries, such as education, where tuition fees may vary based on a student's family income. Overall, sliding scales are a way to promote equity and accessibility in various areas of society.

Here is a sample for Summary of Benefits and Coverage Anthem BCBS of Indiana: https://www.in.gov/isp/files/Active-HDHP-with-HSA-2022.pdf