FAQ

COMMON BILLING TERMS:

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Copayment: 

A fixed amount (for example, $20) you pay for a covered health care service, usually when you receive the service (sometimes called “copay”). The amount can vary by the type of covered health care service.

Deductible: 

The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After you pay your deductible, you usually pay only a co-payment for covered services and insurance covers the rest.

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In-network coverage:

If a provider is in-network, it means the provider has signed a contract with the insurance company to provide services for them. This is sometimes referred to as “on the insurance panel” or “being paneled.” The therapist bills the insurance company directly for an agreed upon payment rate. 

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Out-of-network coverage:

If a provider is out-of-network, this means they are not contracted with your insurance agency. When a provider is out-of-network they are considered a private-pay or cash-pay service. Some insurance plans still offer coverage for out-of-network services. To bill insurance when a provider is out-of-network, the provider may provide their clients with a form called a “superbill” that the client can provide their insurance to be reimbursed for their claim. For example, if you wanted to use your out-of-network benefits, you would pay the full session fee out of pocket at the time of session; following this you would receive a “superbill” form to send to your insurance company for you to be reimbursed. What your insurance is willing to pay for your session with an out-of-network provider depends on your individual plan, so it is important to know what will or will not be covered. For example, if your insurance covers 60% for out-of-network providers, you would pay $200 at the time of session (EDSN's full session fee), then submit a superbill to your insurance, and insurance would send you a check reimbursing you for 60% of that session. This means that your total out of pocket would be $80/session because insurance would be reimburse the $120 that they cover after receiving a superbill. 

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Superbill: 

A superbill is a detailed invoice outlining the services a client received. Therapists may provide a superbill when they are not on a client’s insurance company’s panel. The client submits the superbill directly to the insurer, giving the insurer all the information they need to pay the claim. Superbills provide detailed, specific information about the services a therapist or other health care provider rendered to a client. They may also provide information about the client’s diagnosis. A superbill is distinct from a traditional invoice submitted to the client or insurance. This is because the insurer pays the client, not the therapist. With a superbill, the insurer assumes the client has already paid, and that any payment is therefore a reimbursement.