Plan Coverage: An insurance plan includes not only the terms which the member (you) and the insurance company agree to but also services and reimbursement rates for which a provider (your therapist) is covered. Insurance companies dictate the length of and how often members can attend counseling sessions.
Every insurance company reimburses providers at different rates. When an insurance plan states that the provider will be reimbursed at 100% this means that the insurance company will pay the provider 100% of the rate the insurance company tells the provider they will accept. Providers do not set rates with the insurance companies. Insurance companies set the rates for providers.
PPO: Preferred Provider Organization plan. A PPO insurance plan gives members the most freedom in choosing their own providers. If you have a PPO plan with your insurance company, you don't usually need an authorization prior to booking with a PPO in-network provider.
HMO: Health Maintenance Organization plan. With an HMO plan, you must obtain an authorization number and amount of approved sessions prior to contacting Salveo Counseling. With an HMO plan, your care is coordinated by your insurance company and you must obtain prior approval before seeing providers.
Deductible: The deductible of your insurance plan is the amount you pay out of pocket prior to any insurance coverage is issued. For example if you have a $3000 deductible, you will pay all appointment fees for any in-network provider you see until you have paid at least $3000. Not all plans include a deductible feature and not all services are subject to the deductible.
Co-insurance: The co-insurance of your insurance plan is the portion of the payment due to the provider that you will pay. For example, if your co-insurance is 20% and the rate your insurance will pay is $150, you would owe $30 per visit. This amount is usually paid after the insurance company responds to the visit claim. Not all plans have a co-insurance aspect.
Copay: The copay of your insurance plan is the per visit amount you pay up front. Not all plans have a copay aspect.
Max-out-of-pocket (MOP): The MOP is the total amount your insurance company requires you to pay, after which they will cover 100%. For example if your MOP is $2000 and you have a copay of $20 per visit, once you have paid a total of $2000 per calendar year, you no longer owe the $20 copay per visit. Plan details vary.
In-Network vs. Out of Network: The terms "in-network" and "out of network" refer to the participation status of a provider with a particular insurance plan.
Authorization: If you are being requested to obtain an authorization by Salveo Counseling, you will need to call the phone number on the back of your insurance card and request an authorization for behavioral health sessions with a particular provider at Salveo Counseling Center.