Navigating Your Insurance & Fees

We understand that navigating health insurance can feel overwhelming, especially when you are already focusing on your mental wellness. Please know that you don’t have to figure it out alone—we are here to help you make sense of your coverage so you can focus on what matters most: your growth and healing. To help make things a little clearer, we’ve put together this simple guide to common insurance terms and how they apply to your care with us.

Key Terms to Know

  • The Premium

    Think of this as your monthly "subscription fee" to keep your health insurance active. You (or your employer) pay this every month regardless of whether you have a therapy session.

  • The Deductible

    This is the set amount you pay out-of-pocket for healthcare services each year before your insurance company starts to chip in.

    Most deductibles reset on January 1st. This means even if you met your deductible in December, you will likely be responsible for the full cost of your sessions again starting in January until the new year's limit is reached.

  • The Copay

    A copay is a fixed, flat fee (like $25 or $40) that you pay at the time of each session. Once you’ve met your deductible, this is typically the only amount you owe per visit, making your ongoing care costs very predictable.

How This Looks in Real Life

  • Phase 1

    The "Deductible" Phase: If you have a $1,000 deductible and haven't seen any doctors yet this year, you will pay the full contracted rate for your sessions (e.g., $150 per visit) until those payments add up to $1,000.

  • Phase 2

    The "Copay" Phase: If you have already met your deductible for the year, you now only pay your fixed copay at each visit (e.g., $30). Your insurance company pays the rest of the session cost directly to us.

  • Phase 3

    The "January Reset": It is January 2nd. Even if you were only paying a $30 copay in December, you are now back at the "starting line." You will pay the full session rate again until you meet your new deductible for the current year.

  • Example 1

    1. The "Deductible Applies" Scenario

    In many plans, outpatient therapy is subject to your deductible. This means the insurance pays nothing until you've hit your $1,000 limit.

    Visit 1 Cost: $150.

    What You Pay: You pay the full $150 out of pocket.

    The Result: You now have $850 remaining on your deductible. You won't see that $25 copay kick in until the full $1,000 has been paid toward medical or mental health services for the year.

  • Example 2

    2. The "Deductible Does Not Apply" Scenario

    Some "copay-only" plans allow you to see an in-network mental health provider for just the copay, regardless of your deductible status.

    Visit 1 Cost: $150.

    What You Pay: You pay only your $25 copay at the time of the visit.

    The Result: Your insurance covers the remaining $125. Usually, this $25 copay does not count toward your $1,000 deductible, though it does count toward your "out-of-pocket maximum" for the year.

  • Example 3

    3. Crossing the Deductible Threshold

    Imagine you had a minor surgery earlier in the year that cost you $950, so you've almost met your $1,000 deductible.

    Visit 1 Cost: $150.

    What You Pay: You pay the remaining $50 to hit your $1,000 deductible limit. Once that's hit, the visit switches over to your copay benefits, and you pay the $25 copay for the rest of that session.

    The Total: You pay $75 for this visit ($50 to finish the deductible + $25 copay).

    The Result: For every therapy visit after this one, you will only pay the $25 copay for the rest of the plan year.n goes here