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Mind Your Health

Is Insurance Giving You a Headache?


UMA operates entirely outside of insurance! Transparent prices for each appointment are listed clearly so that you know the cost ahead of time and avoid surprise bills. Create a free account and save your credit card information, so that checkout takes just a few clicks. UMA helps you keep it confidential, with no fear of a paper trail!

Although UMA does not accept insurance payments, we want to help you understand your coverage (or lack-thereof), as we know it can get complicated. We hope you find this glossary of insurance terms helpful. Please stay tuned for additional mental health terms and tips!

Note: If you’re concerned or confused by some of these terms, rest assured that none of these terms will apply to your visit when booking an appointment on UMA. UMA is completely insurance free, meaning when you book an appointment, you are not going through your insurance company. Figuring out what’s covered on your plan and what’s not can be a headache. Paying cash for your next visit is the way to go to avoid unnecessary bills in the mail and charges you’re not aware of.

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Insurance Terms


Allowable Charge

The contracted price your insurance company has negotiated with a provider that it will pay for a service. You may also have to contribute a copay or coinsurance to meet the allowable charge.

Ancillary Fee

An extra fee you may have to pay for prescription drugs that are not on your insurance company’s formulary list of covered items.

Catastrophic Plan

A less expensive plan that offers the most basic coverage with a high deductible. These plans typically require that you are under 30 years-old.

Claim

A request for payment that you or your healthcare provider can submit to your insurance company when you believe something should be covered.

Coinsurance

Percentage of the total cost of a service that you are responsible for paying. Your insurance company pays the other part. Coinsurance rates vary greatly and can be difficult to predict.

Copay

Fixed amount you have to pay per service in addition to what your insurance pays. Copays vary per visit reason and plan.

Deductible

The amount you pay out-of-pocket for care before your insurance company begins sharing the costs. Not all procedures and provider visits will count towards your deductible. This varies per plan.

EPO Plan (Exclusive Provider Organization)

Managed care insurance plan where services outside of an emergency are only covered/can potentially count towards your deductible, if the provider is in the plan network.

Excluded Services

Services your insurance company has dictated it will not pay for. *Even insured patients often have excluded services, in areas like dental care and mental health. UMA is here to help when you’re paying directly!

Formulary

A list formed by your insurance company describing what benefits they offer for certain prescription drugs.

FSA (Flexible Spending Account)

Account through your employer that puts a certain amount of tax-free money aside for various qualified care expenses. You and your employer can both contribute funds to this account.

HRA (Health Reimbursement Account)

Employer-owned and funded account from which employees are reimbursed tax-free for a fixed amount of medical expenses per year.

HSA (Healthcare Savings Account)

Employee/self-owned type of pre-taxed savings account you can put aside if you have a high deductible plan to use towards qualified health expenses. Your employer may contribute to this account as well.

HMO (Health Maintenance Organization)

An insurance plan with which your in-network primary care physician typically needs to refer you in order to see a specialist. HMOs are usually more limited with what doctors they will cover you to see.

Non-Preferred Provider/ Out-Of-Network

Providers not contracted with your insurance. Depending on your plan, your insurance might not cover these doctors, or might charge more. Out-of-network benefits vary per plan.

Out-of-Pocket Maximum

The most money you could have to pay on your own for care within a qualified year. This could be hit after you meet your deductible and have paid the amount set to this point in copayments and coinsurance costs.

PPO Plan (Preferred Provider Organization)

Insurance plan that contracts with certain providers, doctors and hospitals, but also allows you to choose providers out-of-network (you just may have to pay more). With a PPO plan, some out-of-network costs may still count towards your deductible.

Premium

The standard fee you pay once a month to receive coverage offered by a health insurance plan. If you receive insurance through your employer, they may be paying part of your premium and putting some money from your paycheck towards it.

Provider Network

List of doctors your insurance company has a contract with for negotiated prices and terms.