Deductible: The Price of Admission
For those whose mental health services go towards a deductible, think of your deductible like a cover charge
at a concert. Before the band (aka your insurance coverage) starts playing, you have to pay that set amount out-of-pocket.
Example: If your deductible is $1,500, you’ll pay the full allowed cost of therapy sessions until you hit that
$1,500 mark.
Important note: SLC does not decide how much each session costs under your plan. The insurance company sets the allowed amount, and this number varies from plan to plan.
Once your deductible is met, insurance finally joins the party and starts splitting costs with you.
Coinsurance: Splitting of the Check
After the deductible is paid, some plans use coinsurance, which is basically cost-sharing. You and your
insurance split the bill like two friends at brunch (only your insurance usually pays more).
Example: If your coinsurance is 20%, and the insurance company’s allowed amount for therapy is $100, you’ll
pay $20 while insurance covers $80.
Copay: The Flat Cover Fee
Some plans skip the whole deductible/coinsurance thing and just charge you a copay. This is a flat fee per
session—like paying $25 for every yoga class, no matter how long it lasts.
Example: Your insurance says: “Each therapy visit = $25 copay.” Simple. You pay $25, insurance pays the rest.
Out-of-Pocket Maximum: The Safety Net
Here’s the good news: insurance plans usually have an out-of-pocket maximum. This is the absolute most
you’ll have to pay in a year for covered services.
Example: If your out-of-pocket max is $7,000, once you’ve paid that much (through deductibles, coinsurance, and copays), insurance covers 100% of covered costs for the rest of the year. Therapy included.
Prior Authorization: Insurance Asking for Homework
Sometimes, insurance wants to double-check that therapy (or testing) is “medically necessary.” This is called prior authorization—basically a pre-approval note.
👉 Example: It’s like asking permission to adopt a puppy. You know it’s a good idea, but you need official
approval before you can move forward.
The good news? SLC handles prior authorizations for you. We submit the paperwork, follow up with
insurance, and keep you posted.
How SLC Helps You Navigate It All
We know insurance terms can feel like alphabet soup. That’s why we:
- Do complimentary benefit checks before you start.
- Provide clear cost estimates upfront.
- Remind you (a lot) that we don’t set the allowed amounts or reimbursement rates—insurance
companies do. - Translate the fine print into plain English.
Our goal is to make therapy financially predictable so you can focus on what actually matters: your mental
health.
The Bottom Line
- Deductible = pay full cost until you hit the limit.
- Coinsurance = split the bill with insurance.
- Copay = flat fee per session.
- Out-of-Pocket Max = financial finish line where insurance covers 100%.
- Prior Authorization = insurance’s way of asking for a hall pass.
So. Many. Terms. But with a little clarity (and maybe a laugh), they start to make sense.
At Silver Linings Counseling, we’ll walk you through every step—not just in therapy, but in making sure the
money part doesn’t become a second source of stress.