UNDERSTANDING YOUR INSURANCE
Types of Plans
It is important to know not only who your insurance carrier is, but also what type of plan you have. There are three main “types” of insurance plans:
- Medical Assistance (also known as Medicaid)
- CHIP (Children’s Health Insurance Program), which is managed by several different insurance companies like Highmark, Capital, etc.
- Commercial (aka private) insurance plans, which are typically plans through an employer or purchased on the ACA (Affordable Care Act) Marketplace.
Some insurance companies offer more than one type of plan. For instance, UPMC and Highmark offer all three of the plans listed above – commercial, CHIP, and Medical Assistance!
When Campbell Psychological contracts with an insurance plan, we agree to be paid a certain rate for services provided to the plan’s members. Contracted rates are lower than our standard fees. (This is the case for all healthcare providers.) Just as an example, our standard fee for a 60-minute therapy session may be $165, but our contracted rate with an insurance plan might be $125. If you have a deductible or co-insurance, the contracted rate for your insurance plan determines how much you will owe at each visit.
Co-Pays, Co-Insurance, & Deductibles
- A co-pay is a set amount that is owed at each appointment.
- A co-insurance is a percent of the contracted rate that the client owes. The amount due from the client varies depending on the specific service provided, including the length of a therapy session.
- A deductible is a certain amount that the client must pay for their healthcare each year before insurance will begin paying. If we are in-network with a client’s insurance, the client is responsible for the contracted rate until their deductible is met. The deductible re-starts each year when the plan renews. This is often (but not always) January 1st. It is important to know when your deductible re-starts.
A client may have more than one insurance policy. For instance, sometimes kids are covered by both parents’ insurance plans. Or, an adult has insurance through their workplace but is also on a spouse or partner’s plan. Or, the client has commercial insurance but also qualifies for Medical Assistance due to disability (physical or mental health-related).
For more information about multiple policies, visit our webpage about understanding secondary insurances.
A Note about Medical Assistance in Pennsylvania
If you have Medical Assistance, your behavioral health coverage is not provided by same the company that covers your physical/medical healthcare. Your behavioral health insurance depends on the county you live in. For the capital region, including Cumberland county, and for Franklin and Fulton counties, the insurance company is PerformCare.
On rare occasion, a person’s Medical Assistance is provided by the state Department of Human Services, rather than being handled by a separate insurance company.