Understanding Your Insurance: What You Need to Know About the Cost of Sessions
- Jul 9
- 3 min read
By Samantha Proctor MS, LCPC, Murray Mental Health Psychotherapist & Administrative Specialist
With over 10 years of experience as an administrative specialist, one of the most common
concerns I encounter is confusion about how insurance works and what services are covered. If you feel unsure about your benefits, you are not alone. Unfortunately, many schools and
workplaces do not provide education on navigating insurance plans, which can make
understanding your coverage challenging.
This guide is designed to help clarify key concepts and provide a better understanding of your financial responsibility for services. In this blog post, we will cover:
● Common insurance terms and their meanings
● The difference between copayments and deductibles (and how they impact your
out-of-pocket costs)
● Special considerations when using insurance for therapy
● Resources for learning more about your specific coverage
● How insurance is utilized at Murray Mental Health
Key Insurance Terms
Insurance plans often include terminology that can be confusing or similar in meaning.
Below are some of the most important terms to understand:
Copayment (Copay): A fixed amount you pay directly to your clinician at each session. This
amount varies depending on your specific insurance plan and the type of service provided.
Coinsurance: A percentage of the cost of each session that you are responsible for paying.
This typically ranges from 10–20%, though it may vary by plan. Coinsurance usually applies
after your deductible has been met.
Deductible: The set amount you must pay out of pocket before your insurance begins covering services.
Plans may include:
● Individual deductibles, which apply to your personal healthcare expenses
● Family deductibles, which are met collectively by all covered members of your plan
Deductibles generally reset annually. Most plans reset on January 1st of each year, some plans reset mid-year on July 1st.
In-Network: A provider who has a contract with your insurance company. In-network clinicians agree to negotiated rates and bill according to your plan’s benefits.
Out-of-Pocket Maximum: The maximum amount you are required to pay for covered services
in a plan year. Once this limit is reached, your insurance covers 100% of eligible costs.
Premium: The monthly cost of maintaining your health insurance plan. This payment is
separate from session fees and does not count toward your deductible or out-of-pocket
maximum.
Copayments vs. Deductibles
Understanding whether your plan uses a copay or a deductible is key to estimating your costs.
● If you have a copay: You will pay a consistent, fixed amount for each session.
○ For example, a $25 copay means you pay $25 per visit.
● If you have a deductible: You are responsible for the full cost of sessions until your
deductible is met. After that, you will typically pay coinsurance (a percentage of the
session cost).
Once your out-of-pocket maximum is reached, your insurance will cover 100% of covered
services for the remainder of the plan year.
Special Considerations
When using insurance for therapy services, please keep the following in mind:
● Same-day services: Many insurance plans will not cover multiple mental health
services on the same day (e.g., individual and group therapy). To avoid claim denials
and additional costs, it is recommended to schedule these services on separate days.
● Coverage limitations: Some plans may only cover emergency mental health services
or limit the number of sessions per year. While most plans include routine mental health
coverage, exceptions do exist. If your plan does not cover services, self-pay options may
be available.
● Insurance changes: Please notify your clinician promptly of any changes to your
insurance coverage. These changes may be due to change in employment, choosing a
new plan, you have received new insurance cards, or joining a spouse/partner’s plan.
How Insurance Is Used at Murray Mental Health
Murray Mental Health is in-network with several major PPO plans, including:
● Blue Cross Blue Shield PPO
● Anthem BCBS PPO
● Cigna/Evernorth PPO
● United Healthcare (UHC) / United Behavioral Health (UBH) / Optum PPO
● Aetna PPO
● Compsych EAP (select providers)
Please note that being in-network does not guarantee coverage. Final determination of benefits is made by your insurance provider after claims are processed.
If you are unsure about your benefits or would like an estimate of your session costs, please
contact our administrative specialist. Samantha can review your plan and provide a
personalized estimate @ samanthaproctor@murraymentalhealth.com.
Sources
Centers for Medicare & Medicaid Services. (n.d.). Your Medicare coverage.https://www.cms.gov
Healthcare.gov. (n.d.). Glossary. U.S. Department of Health & Human Services.
National Alliance on Mental Illness. (n.d.). Understanding health insurance.
National Association of Insurance Commissioners. (n.d.). Health insurance basics.
Substance Abuse and Mental Health Services Administration. (n.d.). Health insurance and
behavioral health coverage. https://www.samhsa.gov
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