How much will my visit cost?
Your website says that “The majority of visits cost patients $30 or less after insurance.” Does that mean I will pay $30 or less per visit?
While the majority of our visits cost patients $30 or less after insurance*, that's not the case for everyone. Like most doctor's offices, we bill your insurance directly. Based on the details of your plan, your insurer determines your total out-of-pocket cost for that visit. For some people, it's just a copay. If you have an unmet deductible, it could be more.
We have standard rates that we negotiate with insurers for medical services. And we don't receive more money if patients have a greater responsibility. The only factor that affects your cost is the details of your plan. For more information on how that works, read on.
*Includes all types of patient costs: copayment, deductible, coinsurance, and $0 payments. Excludes no-shows. Your medical visit costs can vary depending on your insurance coverage.
What’s a deductible?
A lot of plans have something called a deductible. This is the amount of money you need to pay out of pocket before your insurance will start helping you cover the costs of your medical visits or procedures. It’s set by your insurer and usually resets annually.
Here’s an example: Devon has a plan with a $500 deductible. They see a doctor that charges $250 per visit. Devon would pay the full amount for the first and second visits. After paying $500, Devon’s deductible is met. For any future visits (not just with that provider, but for any other care Devon receives), their insurer would start to cover some or all of the cost, with Devon paying either a copay, coinsurance, or nothing, depending on their plan.
What is a copay?
A copay is a flat fee you pay for each visit. It’s set by your insurer and might even appear on your insurance card. (Keep in mind, for most plans, psychiatrists are considered “specialists.”)
Here’s an example: Let’s say your copay is $30 (and that you’ve already met your deductible, if you have one). Each time you visit a specialist, you’ll just pay $30.
What is coinsurance?
With coinsurance, you and your insurer share the cost of care. You’ll be responsible for a percentage of the total cost, and your insurer will cover the rest.
Here’s an example: You’ve met your deductible, and your coinsurance is 20%. That means you’re responsible for 20% of the total cost of a visit, while your insurer will pay the other 80%.
Who decides how much my visits cost?
Like most doctors' offices, we bill your insurance before we ever send you a statement. Your insurer actually determines your out-of-pocket cost. This is how the process generally works:
1. You have your visit.
2. We bill your insurance directly.
3. Your insurer reviews the claim.
4. They check the details of your plan and determine your out-of-pocket cost.
5. They inform us of how much to bill you.
6. We send you a statement.
It can take a little bit of time for insurers to get back to us, which is why it might take a week or sometimes more to receive a statement for your visit.
