The term deductible refers to a predetermined amount of money a person must pay for covered health care services before their health insurance plan begins to share the costs. It is an out-of-pocket expense that an insured person has to bear before their insurance coverage kicks in.
If the provider they see accepts a health insurance plan, the plan will likely set a specific deductible amount which will need to be met before insurance coverage begins. For example, if the deductible is $1,000, the patient must pay $1,000 for their mental health sessions before insurance begins to also pay the provider.
In-network providers are those within a specified network that have agreed upon set rates with the insurance company. Out-of-network providers, on the other hand, do not have negotiated rates.
The amount of money accepted and applied towards a deductible varies by insurance plans, and can be dramatically different between in-network and out-of-network mental health providers. Regardless of the accepted amount, the patient is responsible for covering the full costs of mental health services until the deductible is met.
After meeting the deductible, insurance starts sharing the costs, known as Coinsurance. But how much the insurance company pays is different between in-network and out-of-network providers.
For in-network providers, the insurance generally covers a larger portion of the costs, requiring less from the patient. Conversely, for out-of-network providers, the insurance coverage is often less, which means the patient may have higher out-of-pocket costs.