109. Does insurance cover the entire cost of treatment?
In a point of service plan, you usually have a deductible. After the deductible is satisfied, the insurance will pay a percentage of the fee, and you will be responsible for the balance. The typical point of
service plan pays either 80%, 70% or 50% of the fee, and you are responsible for the balance. Some plans have a maximum allowable fee for coverage, but most will pay the covered percentage as long as it is less than
the usual customary fee for that service in your geographic area. Some plans pay 100% of the fee after a maximum out-of-pocket expense has been reached. Some plans have a maximum annual benefit. Due to new Federal
regulations, your insurance is not supposed to limit coverage for psychological treatment, if it does not limit coverage for other health care. This is called parity coverage.
In a managed care plan, there is sometimes a deductible, but often there is no deductible. You must use a network provider to receive any coverage, unless you have out-of-network coverage, which works like point
of service coverage. Only treatment that is approved will be covered, and you will be responsible for all non-authorized treatment costs. You are also responsible for a co-pay. Sometimes this is a flat amount, and
sometimes it is a percentage of the total fee. However, if it is a percentage, that amount is based on the negotiated managed care fee, not the provider's usual customary fee.