How Does Insurance Work


No, it’s not just you. Insurance is confusing!

So, What is a “Deductible”?

Most insurance plans have what is called a deductible. This amount has to be paid by the client/patient before the insurance company will start paying. Many plans have a very low deductible, like one or two hundred dollars, but many plans are called “high deductible” and it means just what it says – several thousand dollars is not unusual. All of this is dependent on your employer’s choice of plan, or your choice if you were given more than one option. Alternatively, if you are on an Affordable Care Act plan (commonly called “Obamacare”), you probably have many choices, all with deductibles.

Once you have met your deductible, your plan may start paying 100%. Most often, the plan starts paying a large percentage, and you pay the remainder. A 90/10 or 80/20 plan is very common.

But there are other variables, too, including if there is an out-of-pocket maximum, or is Mental Health a separate benefit paying at a different rate, or does Mental Health get included in the deductible, etc.

The best idea is for you to call the phone number on the back of your insurance card and ask, at a minimum, these questions:

  • Do I have a deductible? How much is it? How much have I met so far this year?
  • Do Mental Health benefits have a separate deductible? How much is it?
  • When I meet it, will I still have to pay anything out of pocket, and how much?
  • When does my deductible start over again?

When you call, the Customer Service Representative should be able to answer your questions. You will want to write down the name of the person you spoke to, as well as a call reference number, just in case a claim is ever disputed.

Insurance is complicated, but we will always try to make it understandable. If you have any questions, please don’t hesitate to ask.