Plan for a conversation
Therapy Cost Explainer
Work through a therapy budget using the rates and benefits you have been quoted. Bring the estimate to your provider or insurer to check the details.
A planning estimate in US dollars, not a bill or coverage decision. Your entries stay on this page and are not saved or sent to us.
Before you book
Questions worth asking
- What is the cost of a full visit, including any separate evaluation or facility fees?
- Is this provider in network, and is this therapy covered for our situation?
- Do we need a referral or prior authorization, and are there visit limits?
- Does a deductible apply, and when does the plan year reset?
- Are there cancellation fees, payment plans, or a self-pay discount?
Understand the numbers
A few useful definitions
- Allowed amount
- The rate your plan recognizes for a covered visit. It can differ from the provider's billed price. [1]
- Deductible
- The amount you pay before the plan starts sharing costs for services subject to it. Some benefits have different rules. [2]
- Copay and coinsurance
- A copay is a fixed amount; coinsurance is a percentage of a covered service's allowed cost. [3] [4]
- Out-of-pocket limit
- A plan-year ceiling for qualifying covered, in-network costs. Premiums, noncovered services, and out-of-network costs are outside this calculation. [5]
Sources & limits
Definitions are based on HealthCare.gov: [1] Allowed amount, [2] Deductible, [3] Copayment, [4] Coinsurance, and [5] Out-of-pocket maximum.
The estimate assumes the same rate and coverage for every visit, no other claims during the period, and no plan-year reset. It excludes premiums, evaluations billed separately, denied visits, balance bills, and cancellation fees. Individual and family benefit rules can differ. Confirm the applicable benefits with your insurer and provider.
Educational content only, not medical advice. Talk to your child's healthcare provider about their specific needs.