When your child begins applied behavior analysis (ABA) therapy at Springtide Child Development Center, you may hear a few new insurance terms. Helping your child with autism get the treatment they deserve should be as straightforward as possible, which is why we’ve compiled a list of the most common insurance phrases you may hear as your child begins their ABA therapy.
A premium is the amount of money that you pay for your health insurance every month. In addition to premiums, you may still be responsible for copays, coinsurance, and a deductible.
If your insurance plan has a deductible, it will be the total cost you will pay out-of-pocket before insurance kicks in to make any additional payments. After you reach your deductible, you will only owe copays or coinsurance for any appointments, prescriptions, or services.
A copay is a fixed cost for a covered appointment, prescription, or service that you, as the patient, are responsible for paying. For example, if you have a $15 copay for a visit to your doctor, you will pay $15 for the appointment, and your insurance will cover the rest.
Coinsurance is a fixed percentage of the total cost of the appointment, prescription, or service that you, as the patient, are responsible for paying. For example, if your coinsurance for a doctor’s visit is 20%, and the total cost of the visit is $100, then you will pay $20 for that visit.
Your health plan has a network of doctors, hospitals, labs and care centers that it works with. In-network providers and facilities have contracts with your health plan to offer services to you at a lower rate for services. Springtide Child Development Center is in-network with most major insurance providers.
Out-of-network providers and facilities do not have a contract or a pre-negotiated rate with your health plan. If you choose to see a doctor that’s outside of your plan’s network, then you may pay higher or even full price for services.
Explanation of Benefits
An Explanation of Benefits (EOB) is an itemized statement you may receive from your health insurance plan that describes what costs it will cover for services you’ve received. You may receive an EOB from your health plan with a description of the services you have received from Springtide. Remember: an EOB is not a bill – it’s just an explanation of costs, what your plan covers, and what you may owe.
A participating provider is similar to an in-network provider. Participating providers have contracts with insurance companies to provide eligible services to patients within their care plan. You can usually find participating providers through your health insurance company’s online portal.
Reach out today and speak with one of our enrollment specialists to get started with Springtide