Insurance
Insurance, in English.
Four numbers decide what treatment costs you. Most people are never told what they are. Start with the tool that matches where you are.
Check your insurance
Six tools
Read my card
What every number on your insurance card means.
Plan types
HMO, PPO, EPO and what each one lets you do.
Is it covered?
What plans usually cover at each level of care.
Call script
The eight questions to ask your insurance company, word for word.
Verify my benefits
Have a person check your benefits and explain them.
Instant benefits check
Enter your plan, see your real numbers in seconds.
The four numbers
What actually decides your bill
- Deductible
- What you pay each year before your plan starts paying.
- Coinsurance
- Your percentage of each bill after the deductible. 20% is common.
- Copay
- A flat fee for a visit or prescription.
- Out-of-pocket maximum
- The most you pay in a year for covered, in-network care. After that the plan pays 100%.
- In-network
- The provider has a contract with your plan and has agreed to its prices.
- Out-of-network
- No contract. The plan pays less, or nothing, and the provider may bill you for the difference.
Questions
The ones everybody has
Does insurance cover rehab?
Most plans do. Under federal law, marketplace plans and most employer plans must cover substance use and mental health treatment, and cannot limit it more strictly than medical care. How much you pay depends on your deductible, coinsurance, out-of-pocket maximum and whether the program is in your network.
What is the difference between in-network and out-of-network?
An in-network program has a contract with your plan and has agreed to its prices. An out-of-network program has not, so your plan pays less or nothing, and the program may bill you for the difference.
What is a verification of benefits?
A verification of benefits, or VOB, is a treatment program calling your insurance to find out what your plan covers. It is an estimate, not a guarantee of payment.
Can insurance stop paying in the middle of treatment?
Yes. Plans approve higher levels of care a few days at a time. Ask the program what happens to your bill if days stop being approved, and remember you have the right to appeal.
Rather have a person do it?
Send us your plan. We will check your benefits and explain them in normal words.