Money & Insurance Words (In Plain Language)
We want to be trauma informed, and we know that money and insurance can quickly activate stress, shame, fear, and shutdown. It is hard to think about healing when you are scared of a bill or a surprise charge. This page is here to slow things down and explain the words you keep seeing in emails and on statements in simple, non‑shaming language.
Why this matters
Insurance companies and medical systems use their own language. That language is often confusing on purpose. When you do not understand it, it is easy to feel stupid, overwhelmed, or like you should just give up and pay whatever they say. We do not want that for you.
You deserve to understand what you are agreeing to and what you might owe before or after a session. Understanding these words will not fix a broken system, but it can give you a bit more power inside of it.
Deductible
What is a deductible?
A deductible is the amount of money you have to pay for covered services each year before your insurance really starts helping with costs. Think of it like a yearly “entry fee” you pay directly to providers.
What this can look like in real life
If your deductible is 2,000 and you have not used any medical care yet this year, you might pay the full session rate for a while, even though you “have insurance.”
Once you have paid that 2,000 in allowed charges, your plan may start paying a portion of each visit, and your cost per session might go down.
Things to ask your insurance company
What is my deductible for mental health or outpatient therapy?
How much of it have I already met this year?
When does my deductible reset (often January 1)?
Copay
What is a copay?
A copay is a set dollar amount you pay each time you go to an appointment. For example, your plan might say “therapy: 25 copay.” That means you pay 25 at each covered visit, and insurance pays the rest of the allowed amount.
What this can look like in real life
You come to therapy, and each session you pay the same 25 at or after the time of service.
Your copay does not usually count toward your deductible if the deductible is already met for that type of service; sometimes it does both. That is why it is important to ask.
Coinsurance
What is coinsurance?
Coinsurance is a percentage of the allowed cost that you pay after your deductible is met. Instead of paying a flat copay, you pay a percentage.
What this can look like in real life
If your plan says “20 coinsurance for outpatient therapy,” and the allowed amount for a session is 150, your part might be 30 and insurance might pay 120.
If the allowed amount changes, your out‑of‑pocket amount changes too, because it is a percentage, not a flat number.
Things to ask your insurance company
Do I have a copay or coinsurance for therapy?
If it is coinsurance, what percentage do I pay?
Is that before or after I meet my deductible?
Out-of-pocket maximum
What is an out of pocket maximum?
Your out of pocket maximum is the most you should have to pay in a year for covered, in‑network services before insurance covers 100 of allowed costs.
What this can look like in real life
If your out of pocket max is 6,000, and between deductibles, copays, and coinsurance you hit that amount, your plan may start paying 100 of allowed costs for the rest of the year for covered services.
This number is usually higher than the deductible and is meant to be a “ceiling” on your yearly medical spending.
In-network vs. out-of-network
In-network
An in‑network provider has a contract with your insurance company to accept certain rates and follow certain rules. Your costs are usually lower with in‑network providers.
Out-of-network
If your out of pocket max is 6,000, and between deductibles, copays, and coinsurance you hit that amount, your plan may start paying 100 of allowed costs for the rest of the year for covered services.
This number is usually higher than the deductible and is meant to be a “ceiling” on your yearly medical spending.
Things to ask your insurance company
Is Purple Sky Counseling in network with my plan?
Is my specific therapist or medication provider in network?
If not, do I have any out‑of‑network benefits for therapy?
Prior authorization / preauthorization
What is prior authorization?
Prior authorization (sometimes called preauthorization or “preauth”) means your insurance company wants extra paperwork and a “yes” from them before they will cover certain services.
What this can look like in real life
Some plans require prior authorization for higher levels of care or certain medications.
If prior authorization is needed and not obtained, insurance may deny the claim and you may be billed.
If you ever see “denied: no authorization” on an Explanation of Benefits (EOB), that is what it is talking about.
Superbill
What is a superbill?
A superbill is a detailed receipt that includes diagnosis codes, procedure codes, dates of service, fees, and provider information. You can submit it to your insurance company yourself to ask them to reimburse you directly for out‑of‑network services.
What this can look like in real life
You pay Purple Sky out of pocket for sessions.
We provide a superbill upon request.
You send the superbill to your insurance company (usually through their portal or by mail).
If you have out‑of‑network benefits, they may reimburse you for part of what you paid.
Explanation of Benefits (EOB)
What is an EOB?
An Explanation of Benefits is a document your insurance company sends after a claim is processed. It shows what was billed, what they allowed, what they paid, and what they believe you owe.
Important note
An EOB is not a bill from Purple Sky. It is the insurance company’s record. If you are confused by an EOB, you can contact both us and your insurance company to get clarity before panicking.
Why we ask you to double check your benefits
We will do our best to verify insurance, but we are not your insurance company and we cannot control how they ultimately process claims. We ask you to call them and ask clear questions because that is the best way to reduce surprise bills and misunderstandings.
It is completely valid to feel angry that the system is this confusing. You are not stupid, lazy, or “bad with money” because you do not understand insurance language. The system was built this way; you are doing your best inside it.
How we try to help
Within this messy system, our team will do our best to:
Explain what we know and what we do not know yet
Let you know when a bill is getting too large
Set up payment plans when possible
Talk honestly with you if something is not sustainable, financially or emotionally
We also reserve the right to pause or cancel appointments when insurance changes, a balance gets too high, or we cannot reach you despite multiple attempts—not because we do not care, but because we have to keep the practice sustainable enough to keep the doors open for you and for other clients.
