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 session costs are determined
Tava providers set their own rates for clients paying out of pocket. When you use insurance, however, Tava is required to bill at a standard rate, typically higher than the provider's direct rate.
Your insurance plan then sets a maximum "allowed amount," the figure your insurer uses to calculate what you actually owe. For example, Tava may bill $341 for a session, but if your plan's allowed amount is $131, your cost is based on $131, not $341.
How your deductible affects what you pay
If you haven't yet met your deductible for the year, you may owe the full allowed amount per session. Once your deductible is met, you'll typically owe only a copay or coinsurance, which is usually much lower.
Example: Tava bills your insurance $341. Your plan's allowed amount is $131. Because your deductible hasn't been met, you owe the full $131. If your deductible had been met, you might owe only a small copay instead.
Why insurance sometimes costs more than cash pay
If your deductible hasn't been met and your provider's cash-pay rate is lower than your plan's allowed amount, you may end up paying more through insurance than you would paying directly. This is sometimes a component of how insurance billing works.
If you're unsure whether your deductible has been met, call the Member Services number on the back of your insurance card to confirm.
In-network vs. out-of-network coverage
When your insurance is verified, your Tava 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. You can also contact your insurance carrier directly to confirm network 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.