We are here to help you navigate through the world of insurance terms.
Verification of Benefits: Checking the status of a given patient's insurance coverage as well as verifying their eligibility for having a given service covered.
Explanation of Benefits (EOB) :
You may receive an EOB from your health plan after your visit with the provider. It will show you the total charges for your visit and how much you and your health plan owe. An EOB is NOT A BILL. You can also use it to track how you and your family use your coverage.
Copay: A flat rate fee that you pay toward speech therapy services or other medical care.
Deductible:
The amount you pay for covered health care services before your insurance plan starts to pay.
Coinsurance:
The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.
Out of pocket maximum:
The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits. The out-of-pocket limit doesn't include: Your monthly. premiums.
Visit limit:
The maximum number of visits your insurance benefits will cover.
Prior Authorization (PA):
Pre approval from your insurance company that requires medical review. Simplicity will apply for prior authorization on your behalf if your insurance requires it.
