Before starting with any ABA company, we encourage you to call your insurance and have them explain your benefits to you. The Helm ABA is an in-network provider with Aetna, Anthem, Baylor Scott and White, BCBS, Cigna, Healthsmart United Healthcare, and UMR.
Knowing and understanding your benefits is important to your financial health as you search through which policies are best for your family.
Here are some common terms you may come across.
Coinsurance: the amount you pay to share the cost of covered services after your deductible has been paid. The coinsurance rate is usually a percentage. For example, if the insurance company pays 80% of the claim, you pay 20%.
Co-payment: You pay a flat fee for a service, while your insurance company pays the rest. For example, you pay $20 and insurance covers the rest.
*Ask your insurance if your co-pays go towards your deductible and/or your out-of-pocket max.
Deductible: the amount of money you must pay each year to cover eligible medical expenses before your insurance policy starts paying. In ABA you will highly likely reach your deductible.
Explanation of Benefits (EOB): a written explanation of how a medical claim was paid. These will be mailed to your home or can be accessed on your insurance portal.
*Note the EOB will reflect what your responsibility will be for payment to the provider once the provider has issued an invoice, not what has actually been paid so far.
In-Network Provider: an ABA provider that is part of a health plan’s network of preferred providers. Generally, you pay less for services received from in-network providers because of negotiated rates.
Out-of-Network Provider: an ABA provider that is not part of a health plan’s network of preferred providers. Generally, you pay more for services received from out-of-network providers. Since your ABA company does not have a contract with this insurance it tends to be riskier to work with an out-of-network provider.
Out-of-Pocket Maximum: the total money you will pay during a year for coverage. After this amount everything is covered by insurance.
During open enrollment there are options to sign up for child-only policies if your employer’s plan does not cover ABA. We highly encourage you to work with an insurance broker to find the best plans for you! Here is a link for open enrollment, www.healthcare.gov.