Glossary of Insurance Terms
Allowed Amount: The maximum amount a plan will pay for a covered health care service. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”
Balance Billing: When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A Preferred Provider may not balance bill you for covered services. Nicklaus Counseling Center is a Preferred Provider.
Coinsurance: The percentage of costs of a covered health care service you pay after you've paid your deductible.
Coordination of Benefits: A way to figure out who pays first when 2 or more health insurance plans are responsible for paying the same medical claim. As the patient you call the customer service number located on the back of your insurance card and answer some brief questions. Failure to do this may result you being responsible for 100% of the Whole Billed Amount.
Copayment/Copay: A fixed amount ($20, for example) you pay for a covered health care service at each time of service.
Deductible: The amount you pay for covered health care services before your insurance plan starts to pay. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services.
Services may be covered in full or in part by your health insurance or employee benefit plan. Please check your coverage carefully by contacting your health insurance carrier and asking the following questions:
It is your responsibility to pay for what insurance does not cover at each session on the day of the appointment, i.e. copays, self-pays, late cancels, no call/ no show fees.
We Offer Services For Adults, Children, and Adolescents
Nicklaus Counseling Center, Marinette, WI
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