Understanding how insurance billing works can help you avoid surprises when your statement arrives. This article explains how session costs are calculated, what your deductible means for your out-of-pocket costs, and how in-network coverage affects what you pay.
How sessions are billed to insurance
After your therapy session, Tava Health submits a claim to your insurance carrier. Your insurance carrier then processes (adjudicates) the claim and determines how your plan applies to the session—including the amount covered and the amount you owe (patient responsibility).
Your final cost may depend on:
Your plan’s deductible, copay, coinsurance, and out-of-pocket maximum
Whether your provider is considered in-network
The allowed amount set by your insurance plan
How your insurance carrier categorizes and processes the therapy session
Other claims, plan changes, or coordination with another insurance plan
After your insurance carrier finalizes the claim, Tava Health will charge your card on file for the amount you owe and send a confirmation email. For more information, see What You Owe After Insurance Pays.
How session costs are determined
When you use insurance, Tava Health bills at a standard rate. Your insurance plan then sets a maximum “allowed amount,” which is the figure your insurer uses to calculate what you actually owe.
For example, your plan’s allowed amount could be $131, even if the provider's direct rate is different.
If your deductible has not been met and your provider’s cash-pay rate is lower than your plan’s allowed amount, you may pay more through insurance than you would by paying directly, until your deductible is met. This can happen because insurance cost sharing is based on your plan’s allowed amount and benefit rules.
How your deductible affects what you pay
If you have not yet met your deductible for the year, you may owe the full allowed amount for a covered session. Once your deductible is met, you may owe only a copay or coinsurance, depending on your plan.
For example:
Tava Health bills your insurance the standard rate.
Your plan’s allowed amount is $131.
Because your deductible has not been met, you owe the full $131.
If your deductible had been met, your plan might instead apply a copay or coinsurance.
How we estimate copays
Tava Health cannot guarantee or confirm your exact copay before your insurance carrier processes the claim. We may provide an estimate based on the insurance information available at the time, but an estimate is not a bill or a guarantee of your final cost.
Your final amount may be different if your deductible or out-of-pocket balance changes, your benefits change, or your insurance carrier applies different rules during claim processing. For more information, see How We Estimate Session Costs.
How therapy sessions are categorized
Tava Health does not determine how your insurance carrier categorizes a therapy session for claim processing or cost sharing. For example, your carrier may apply different benefits depending on whether it processes a session as an office visit, specialist visit, behavioral health visit, or another service category.
Contact your insurance carrier to ask:
How outpatient therapy sessions are categorized under your plan
Whether the session is subject to a copay, deductible, or coinsurance
How that categorization affects the amount you owe
In-network versus out-of-network coverage
When your insurance is verified, your Tava Health provider will be shown as in-network or out of network on your profile. Choosing an in-network provider means your insurance can be applied to your sessions, subject to your plan’s benefits.
We always recommend contacting your insurance carrier directly to confirm network coverage and associated costs. For help setting up or verifying your insurance, see Setting Up and Verifying Your Insurance.
How to get clarity on insurance coverage
Your insurance carrier can provide the most accurate, up-to-date information about your coverage. Call the Member Services number on the back of your insurance card and ask about:
Whether therapy sessions with your Tava Health provider are covered and considered in-network
Your copay, deductible, coinsurance, and out-of-pocket maximum
How much of your deductible and out-of-pocket maximum you have met
How therapy sessions are categorized for claims and cost sharing
How the applicable service category affects your cost
You can also review your policy documents, benefits summary, or insurance member portal for details about behavioral health and outpatient therapy coverage.
For help setting up or verifying your insurance, see Setting Up and Verifying Your Insurance. If you've received an unexpected charge, see Unexpected Charges or Billing Issues.