How does my health insurance work?

Your insurance card will tell you things like the name of the insurance company, your ID and Group number, customer service phone numbers, what type of plan you have, and sometimes copay and deductible information. To learn more about how to interpret the information on your insurance card, see this insurance guide.

Most insurance companies have an online portal that provides your coverage information. They also have provider lists to search for in-network providers. You can create an account on your insurance company’s website to access that information.

That depends on several factors. There is a standard fee that your provider will charge per appointment. These costs are based on the type of service provided and what level of expertise the provider has.

Your insurance pays an allowed amount of that fee, which is the amount they are willing to pay for the services you receive. These amounts can vary.

You will likely have a copay, which is the amount that your insurance company requires you to pay per service.

These costs vary depending on if your healthcare provider is in network (meaning they have a contract with your insurance company) or out of network (meaning your provider does not have a contract with that health insurance company). Costs are frequently lower for in network providers.

Sometimes, your benefits have a deductible, which is the amount your insurance company requires you to pay out of pocket before they will start covering certain services. Deductibles start over every year, usually on January 1, but that also depends on your specific insurance plan.

You can usually find a breakdown of costs in your account on your insurance company’s website. You can also call the customer service number on the back of your card and ask them specifically how much your costs will be per service. Please note that some insurance companies may have a separate phone number for Mental/Behavioral Health.

 

Some of the main questions you will want to ask are:

• Does my insurance cover _____? (The services you are seeking. For example, mental health, gender affirming care, birth control, psych evaluations, screenings for learning disabilities, etc.)
• How much is my copay?
• Do I have a deductible? If so, how much is it?
• (If you have a deductible) Is there a coinsurance fee once my deductible is met?
• Will virtual sessions be covered, and if so, is my copay different for virtual vs in person sessions?
• (If you know of a specific provider you’d like to see) Is [provider name] in network with my insurance?
• (If they are not in network but you’d still like to work with them) How much are costs for out of network providers?

Once you have an understanding of how much things will cost and what your insurance can cover, you can begin looking for a provider.

If you’re looking for medical, dental, or eye care, check your insurance company’s provider directory to find out who is in network and is accepting new patients. You can filter your search by location or specialty.

You can also look on your insurance company’s provider database to find mental health providers, but there are also a few other databases to search. All of the websites below allow you to search by location, specialty, insurance company, and identity of the provider.

• https://www.psychologytoday.com/us
• https://www.portlandtherapycenter.com/
• https://www.therapyden.com/