Your Guide to Understanding Insurance Vocabulary

Insurance can be tricky even for the most intelligent consumers!   With the exception of University of Utah HMHI plans, we no longer accept insurance.  Unless you have U of U HMHI (in which case, stop here this page doesn’t apply to you) you might be submitting a super-bill to your insurance plan and need some help navigating the system. Here are some new vocabulary words to help you sound like an insurance consuming genius in no time!

Super-bill:  So sorry disappoint but this Bill doesn’t wear a cape and there’s nothing too exceptional about it. It’s a statement you’ll receive from our office reporting the medical services  received,  diagnosis and date of service along with fees and the amount paid for the service.

Out of Network Deductible: This is the amount you have to pay out of pocket, directly to your provider before your insurance begins reimbursing you for services you’ve paid for.  How does your insurance know what you pay? You sly genius, you’re already picking up on it.  It’s because you’ve submitted your super-bill proving that you’ve paid your bills and are adulting at the highest of levels. Once you’ve met your out of network deductible your insurance will kick in and start reimbursing you (at a rate of their choosing) for your services.  You’ll still pay us up front, submit your own bills and be responsible for doing the tango with your insurance company.  

How to do the insurance tango: Call the nice people at your insurance company and ask if your plan provides you with out of network benefits. (If you don’t have out of network benefits, stop here.  You’re among the unfortunate majority of the population.  Your other options are an HSA card and/or government healthcare reform.). Ahem, back to out of network benefits…If the insurance person asks what CPT code we use it is typically 90837. (Google: CPT codes, if you suffer from insomnia they’ll put you straight to sleep)  If they do provide you with this benefit then you’ll want to ask how and where to submit your super-bill for reimbursement.   You’ll also want to record the out of network deductible amount, how much you’ll be reimbursed per therapy session, when to expect payment and by what method (ie check, direct deposit etc).  Hopefully your insurance company is the exception to the rule and gives you clear, concise responses and a quick turn around on that reimbursement money.

Health Savings Account (HSA):  This is a debit card that can only be used to cover health costs.  We don’t make the rules and all agree that shopping is a form of therapy too, but your HSA card won’t work at your favorite store.  All of the money you put in your HSA account is tax free and a great way to pay for therapy and save a little cash on taxes, who doesn’t like that deal?!

EOB:  This is a short way of saying, Explanation of Benefits.  You’ve probably seen one of these before from your insurance company, you’ll be getting one in the mail from your insurance carrier that will account for your visits with us.  If you can decipher the details on this statement (which I trust you can after learning all of these new vocabulary words!) you’ll be able to know: 1. If you’ve met your out of network deductible yet, 2. If you will be getting a reimbursement from your insurance company for the amount you’ve spent for that particular session 3. Allowable Amount (this is how much money the insurance company reimburses for the services rendered).  Often the EOB will accompany reimbursement checks which will account for the service you’re being reimbursed for.  

Finally, call your mom, your boss, or anyone else you want to impress and let them know you received a gold star in adulting today since you finished reading this page!