--- title: Insurance terms, made simple description: >- Plain-language definitions of common insurance terms, from deductibles to superbills, to help you feel prepared for your child’s mental health care. category: Page canonical_url: https://www.brightline.com/pricing/insurance/insurance-terms-glossary/ source: Brightline license: © 2026 Brightline. All rights reserved. slug: pricing/insurance/insurance-terms-glossary id: 3CdFlQXLX2R2xDPHlTqoe1 contentType: page --- A plain-language guide to insurance terms like deductible, copay, and superbill, so you know what to expect for your child’s therapy, psychiatry, or testing. # Insurance terms, made simple Insurance comes with a lot of unfamiliar words. And when you're looking for therapy, psychiatry, or psychological testing for your child, the last thing you need is more confusion. We're here to help make things a little easier. This guide explains common insurance terms so you can better understand what's covered, what you might pay, and what to expect as you find the right mental health care for your child. Every insurance plan is a little different, so it's always a good idea to check with your insurance company for details about your family's coverage. ![Holiday happiness: How to model balance and joy for your kids](https://images.ctfassets.net/96gdpqkm7elu/4N4yzZ3w2AbRYzg1HvEEQF/56ddd004d7871aeee8542a11cb5b2c2a/pexels-cottonbro-4039148.jpg?w=2560&fm=webp&q=75) - [I’m ready to schedule](/care/appointment/) - [(888) 255-7040](tel: 8882557040) ## Insurance terms ### Allowed amount / negotiated rate The price your insurance company has agreed to pay for therapy, psychiatry, or psychological testing. If your provider is in-network, they've agreed to accept this price for covered care, even if they normally charge more. What you owe is usually based on this amount. ### Balance billing When an out-of-network therapy, psychiatry, or psychological testing provider charges you the difference between their regular price and what your insurance pays. In-network providers generally can't charge you this difference for covered care. ### Behavioral health benefits administrator Some insurance companies have a separate company that handles mental health coverage, including therapy, psychiatry, and psychological testing. If yours does, you may see a special mental health phone number on your insurance card. That's a good place to start when you have questions about your child's coverage. ### Billing code (CPT) A number that tells your insurance company what kind of care your child received, like a therapy session, psychiatry appointment, or psychological testing. You can share this code with your insurer to ask how much a specific appointment or evaluation might cost. ### Claim A request for payment that your therapy, psychiatry, or psychological testing provider sends to your insurance company. Your insurance company reviews it, decides how much it will pay, and lets you know what you may owe. ### Coinsurance The percentage of a covered therapy, psychiatry, or psychological testing cost you pay, usually after meeting your deductible. For example, if your coinsurance is 20% and the allowed amount for a therapy session is $100, you pay $20 and your insurance pays $80. ### Copay / copayment A set amount you pay for an appointment, like $30 for a therapy session or psychiatry visit. Depending on your plan, you may pay this amount from your first appointment or after meeting your deductible. ### Covered service / covered benefit Mental health care your insurance plan helps pay for, such as therapy, psychiatry, or psychological testing. Even when your child's care is covered, you may still need to pay part of the cost. ### Deductible The amount you pay for covered care before your insurance starts sharing certain costs. For example, if your deductible is $1,000, you may need to pay the full insurance-approved cost of your child's therapy or psychiatry appointments until you've paid $1,000 toward your deductible. After that, your insurance typically starts paying its share. Some mental health services may be covered before you meet your deductible, depending on your plan. ### Dependent Someone covered by another person's insurance plan, like a child covered by a parent's plan. Children can generally stay on a parent's health insurance plan until age 26. ### Diagnosis code (ICD-10) A code that tells your insurance company what condition your child is being evaluated or treated for. Insurance companies generally need this information to process claims for therapy, psychiatry, or psychological testing. The code may also appear on insurance statements sent to the person who holds the plan. ### Explanation of benefits (EOB) A statement your insurance company sends after reviewing a claim for your child's therapy, psychiatry, or psychological testing. It shows what your provider charged, what insurance paid, and what you may owe. **Good to know:** An EOB isn't a bill. Your provider will send you a bill if you have a balance to pay. ### Good faith estimate A written estimate of how much your child's therapy, psychiatry, or psychological testing is expected to cost. If you're paying for care yourself instead of using insurance, your provider generally must give you one under federal law. If you're using insurance, you can still ask about expected costs before getting started. ### HMO / PPO / EPO / POS These are different types of insurance plans. The biggest difference is which therapy, psychiatry, or psychological testing providers you can see and whether you need a referral. - **HMO:** Usually covers care only with in-network providers. You may need a referral from your child's primary care doctor. - **PPO:** Gives you more flexibility to see in-network or out-of-network providers. Staying in-network usually costs less, and referrals typically aren't needed. - **EPO:** Usually covers only in-network providers, but you typically don't need a referral. - **POS:** Combines features of HMO and PPO plans. You may have some out-of-network coverage, but referrals are often needed. ### Individual deductible vs. family deductible Family insurance plans often have two deductibles: - **Individual deductible:** The amount one family member needs to pay before insurance starts sharing certain costs for that person. - **Family deductible:** The total amount your family needs to pay together before insurance starts sharing those costs for everyone. These deductibles can affect how much you pay for your child's therapy, psychiatry, or psychological testing. How they work together depends on your plan. ### In-network / participating provider A therapy, psychiatry, or psychological testing provider who has an agreement with your insurance company about what they'll charge for covered care. Choosing an in-network provider usually means you'll pay less. Your insurance company's list of in-network providers is called its *provider network*. ### Insurance carrier / payer Another name for your insurance company, like Aetna, Cigna, or UnitedHealthcare. ### Medical necessity The rules your insurance company uses to decide whether therapy, psychiatry, or psychological testing is needed to diagnose or treat your child's mental health condition. For example, your insurer may review whether psychological testing is medically necessary before agreeing to cover it. ### Member ID / group number Numbers on your insurance card that help identify your coverage. - **Member ID:** Identifies you or a covered family member. - **Group number:** Identifies your insurance plan, often through an employer. Your therapy, psychiatry, or psychological testing provider may ask for these numbers to check your child's benefits. ### Mental health parity A federal rule that helps make sure mental health care, including therapy, psychiatry, and psychological testing, is covered fairly compared with physical health care. For example, most health plans generally can't have stricter limits or higher copays for mental health care than for similar medical care. ### Network gap exception / single-case agreement A special arrangement your insurance company may make when an in-network provider isn't available to meet your child's mental health needs. For example, if you can't find an in-network provider who offers the psychological testing your child needs, your insurer may agree to cover an out-of-network provider at in-network costs. These arrangements usually need approval ahead of time and aren't guaranteed. ### Out-of-network / nonparticipating provider A therapy, psychiatry, or psychological testing provider who doesn't have an agreement with your insurance company. Depending on your plan, insurance may cover some of the cost or none at all. You may also be responsible for charges that insurance doesn't pay. ### Out-of-network benefits Coverage your plan may offer when your child sees a therapy, psychiatry, or psychological testing provider who isn't in-network. You may pay more for these appointments, but your insurance company might reimburse you for part of the cost. Some plans don't include out-of-network benefits. ### Out-of-pocket costs The money you pay yourself for your child's therapy, psychiatry, or psychological testing. This can include your deductible, copays, and coinsurance. You might also see these costs called your *patient responsibility*. ### Out-of-pocket maximum The most you'll have to pay for covered, in-network care during your plan year, including covered therapy, psychiatry, and psychological testing. Once you reach this amount, your insurance generally pays 100% of covered, in-network care for the rest of that plan year. Family plans may have separate individual and family maximums. Monthly premiums and certain other costs don't count toward this limit. ### Plan year / benefit year The 12-month period your insurance coverage follows. Your deductible and out-of-pocket maximum usually start over when a new plan year begins. This can affect what you pay for your child's therapy, psychiatry, or psychological testing. For some families, the plan year begins January 1. For others, it's a different date. ### Prior authorization / preauthorization Approval your insurance company may require before your child receives certain mental health services, especially psychological testing. If approval is required but isn't received, insurance may not cover the care. **Helpful tip:** Ask whether prior authorization is needed before scheduling therapy, psychiatry, or psychological testing. Approval also doesn't always guarantee payment. ### Referral A recommendation from your child's primary care doctor to see another provider, such as a therapist, psychiatrist, or psychologist who offers testing. Some insurance plans require a referral before they'll cover certain mental health appointments. ### Subscriber / policyholder The person who holds the insurance plan, often through their employer. For example, if your child is covered under your insurance, you're usually the policyholder and your child is a dependent. Insurance statements for your child's therapy, psychiatry, or psychological testing are often sent to the policyholder. ### Superbill A detailed receipt from your therapy, psychiatry, or psychological testing provider that includes the care your child received, billing codes, and payment information. If you're seeing an out-of-network provider, you may be able to send a superbill to your insurance company to request reimbursement. ### Telehealth / virtual care Therapy or psychiatry appointments that happen over secure video instead of in person. Many insurance plans cover virtual mental health visits, but coverage and costs can vary. It's always worth checking with your insurer. ### Verification of benefits A check to see whether your child's insurance is active and what mental health care the plan covers. This can help you understand the costs of therapy, psychiatry, or psychological testing, including copays, deductibles, and whether approval is needed before care begins. ### Visit limits / session limits Rules about how many therapy or psychiatry appointments your insurance plan will cover within a certain period. Some plans may review your child's care after a certain number of sessions to decide whether continued treatment meets their coverage rules. Psychological testing may have its own coverage limits or review requirements. Federal mental health parity rules help protect families from unfair limits on mental health care. ## A little reminder before you go - You don't have to become an insurance expert to get your child the mental health care they need. - Understanding a few key terms can help you feel more prepared, ask the right questions, and know what to expect when it comes to the cost of therapy, psychiatry, or psychological testing. - And when something doesn't make sense? It's always okay to ask. Your insurance company can help explain the details of your plan, and your care team may be able to help you understand the next steps. ![Online therapy or coaching session - meta](https://images.ctfassets.net/96gdpqkm7elu/6ck77K3jQtNkaMiN8SXqPK/446ff99f3f2f89e9005cd572eef52d76/pexels_katerina_holmes_5905709_1_2eb80f7673.jpg?w=2560&fm=webp&q=75) ## Get started After you reach out, a member of our engagement team will be in touch to talk through what your family is experiencing and get your first appointments scheduled. The process is straightforward, and we'll guide you through every step. - [I’m ready to schedule](/care/appointment/)