You may see these common insurance terms around. For your exact costs, reach out to your insurance company directly.
A claim is a request for payment sent to your insurance. This can be made by your provider or you. At Brightside, we handle this for you when you pay with insurance.
For example, after you have an appointment with a Brightside provider, you might see that a “claim is processing” on your insurance account. Once processed, you’ll receive any bills from Brightside for your out-of-pocket cost.
Coinsurance is the amount you pay to share the cost of care with your insurance company. This happens after your deductible has been paid. For example, your insurance may cover 80% of costs but you pay 20%.
A copay (or copayment) is a flat charge you pay every time you see your provider. This is charged by your insurance when they are covering your care.
Copay amounts vary from plan to plan. You may have a different copay for seeing a Brightside provider than you will for picking up a prescription at the pharmacy or going to urgent care.
“You’re covered.” “Your insurance covers treatment.” “Check your coverage.” You may hear all of these phrases, but what does coverage mean?
Coverage refers to when care is included—meaning your insurance will pay for all or some of the cost. At Brightside, we partner with insurance companies so that our care is covered and more affordable.
A deductible is the amount of money you pay towards health care costs each year before your insurance starts paying. This amount is set by your plan.
Explanation of benefits
This is provided by your insurance and explains how a claim was paid. It contains detailed information about what your insurance company paid, and what costs (if any) you are responsible for paying.
It’s a good idea to call your insurance company if you need any help understanding an explanation of benefits.
A Health Savings Account (HSA) or Flexible Savings Account (FSA) is a savings account that lets you put pre-tax money aside for eligible medical expenses.
This could include doctor appointments, prescriptions, and therapy sessions. Depending on your account, you may be able to pay for Brightside with your HSA or FSA.
This refers to any payment you have to pay yourself. It includes your deductible, copays, coinsurance, and any payments made for care that wasn’t covered.
Your out-of-pocket maximum is set by your insurance company. It is the most amount of money you will pay during a year for coverage. It includes your copays, deductible, coinsurance, and premiums. Beyond this amount, your insurance will pay the rest of the expenses for the year.
A premium is the amount you or your employer pay each month for your insurance.