Allowed Amount: Your allowed amount is the maximum your plan will pay for a covered healthcare service. It is also called an "eligible expense," "payment allowance," or "negotiated rate." You may have to pay the difference if your provider charges more than the plan's allowed amount.

CPT Code: Current Procedural Terminology (CPT) codes provide a uniform for coding medical procedures and services that insurance companies use to bill for services.

Coinsurance: Some plans have coinsurance, a form of cost-sharing that allows you to split the cost of care between you and your insurance company. Most insurance plans with coinsurance require you to pay a percentage of the cost of care after you’ve met your deductible. For example, let's say your allowed amount for an office visit is $100, and your coinsurance is 20%. If you've already met your deductible, then you will owe 20% of $100, or $20, with your insurance company paying the rest. If you have not yet met your deductible, then you will pay the full allowed amount.

Copay: A copay is your contribution towards the cost of a health care service. Copay amounts vary depending on plan and type of treatment or service. Health care providers will bill you directly for an copays you owe.

Deductible: A deductible is a form of cost sharing where your insurance company does not start paying for in-network care until you have paid the deductible amount yourself in full. Let’s say you have a $1,000 deductible. You will pay for your nutrition counseling sessions in full until you have accumulated $1,000 worth of medical charges. Usually, deductibles reset every policy year. Once you meet your plan’s deductible, most insurance providers typically only require a copay or coinsurance for additional covered services up to an out-of-pocket maximum.

Preventive care: Preventive care is routine health care that can include annual wellness check-ups, screenings, tests, counseling, flu shots and vaccinations. For some plans, nutrition counseling falls under preventive care. Some plans will have 100% coverage for preventive care, so service is at no cost to the patient; other plans will require a copay or coinsurance to cover preventive care, and might have other limits (such as number of sessions covered).

Superbill: A superbill is a detailed list of services provided by a health care provider to a patient, and is used for out-of-network health care billing. The superbill includes diagnosis and procedure codes, and other important information that your insurance company needs in order to reimburse you for your out-of-network services. When you receive a superbill, submit it to your insurance company to get reimbursed directly. Always check if you can get reimbursed for out-of-network services!

While we are proudly in-network with most major health insurance companies, coverage can vary depending on your specific provider and plan, so it’s important to check! Be sure to write down the information you receive and bring it with you to your first appointment.

We created a downloadable guide to walk you through the process of verifying your benefits that includes all the info you need, such as diagnosis codes and a script of questions to ask.