Therapy & Insurance: A Comprehensive Guide
Health insurance can often feel confusing and overwhelming—especially when you're faced with unfamiliar terms, a variety of plan options, and unexpected costs. Whether you're selecting a plan for the first time or considering a switch, it's completely normal to have questions about what things like deductibles and copays actually mean—and how to choose a plan that truly works for you.
At Tamarasa Therapy, we're here to help break down the basics of insurance terminology, guide you through what to consider when picking a plan, and support you in finding coverage that meets your needs. Our goal is to empower you with the knowledge and confidence to make healthcare decisions that support your mental and emotional well-being.
As we approach open enrollment for 2026, we want to ensure you feel prepared to make informed choices—so you can keep the care you rely on, including your therapist or other professional services, without interruption
A Guide to Common Insurance Terms
Health insurance can feel like a foreign language, and if you're feeling confused, you're definitely not alone. Terms like deductible, copay, and network can make it tough to understand what you're actually paying for. Let’s simplify some of the most common terms so you can feel more confident and informed when making decisions about your care.
Copay: A copayment is a fixed fee you pay when using a healthcare service or purchasing a prescription. This amount doesn’t change, even if you haven’t met your deductible yet. Copays can be different at different offices; for example, your Primary Care Physician (PCP) probably has a different copay than a Specialist (like a cardiologist) visit.
Deductible: A deductible is the amount of money you have to pay before your insurance starts helping you. For example, if your deductible is $1,500, you’ll need to pay for doctor visits yourself out of pocket until you’ve paid the full $1,500. After that is paid, your insurance will help cover the costs. Usually, once someone meets their deductible, a co-insurance amount then applies.
Deductible Payment: This is the full session fee you would pay if you have a deductible that has not been fully met yet. This amount may vary based on which insurance you have. They are based on the contracted rates the insurance companies have with the provider.
Premium amount: The premium amount is the amount you’ll pay every month to keep your insurance plan. Make sure to pick something within your budget. You’ll notice there are plans with very low premiums, but that usually means high deductibles and high copayments. There are plans with very high premiums, but that may mean low or no deductibles and copays. More on this below.
Co-Insurance: Co-insurance is the part of the cost you pay after you’ve already paid your full deductible. It’s a percentage of the total price. For example, if you were paying $100 per visit to see your regular doctor and your co-insurance is 20%, then you would pay $20 each time after your deductible is met. So before you paid $100, now and for the rest of the year, you only pay $20 for that service.
Out-of-Pocket Maximum: This is the limit on how much you will pay towards prescriptions and services in a given year. This usually includes both deductible payments and copayments. Once you’ve hit this maximum, you will not pay for services or prescriptions, and insurance will cover everything fully.
PPO: PPO stands for Preferred Provider Organization. It is a type of health insurance plan that means you can visit clinicians in your network without a referral from your physician, and you will pay less money. If you have a PPO, the variety of providers you can see and get coverage will be bigger than those of a HMO.
POS: POS stands for Point of Service. With a POS plan, you pick one main doctor (called a Primary Care Physician, or PCP). If you want to see a specialist or go to a different doctor, your main doctor needs to give you a referral (kind of like a note saying it’s okay). With this plan, you can only save time and money if you see your chosen physician. You can see someone outside of the network, and insurance may help you pay for some of it. As of July 2025, referral requirements were suspended for North Carolina based insurances for behavioral health services since 2020.
HMO: HMO stands for Health Management Organization. This plan is like a POS plan where you pick a main doctor, and if you want to see someone else, you must receive a referral. However, this type of plan won’t help pay for costs at all if you see someone out of network.
Prior Authorization: Some services and plans will require a prior authorization – that is, you must fill out a form to ask insurance for approval to help you pay for a service or prescription. Prior authorizations usually come with limits; for example, if your mental health therapy needs prior authorization, they’ll usually limit how many times you can come in.
In-Network: An in-network provider, service, or prescription means insurance has pre-determined it’s okay to see this person or use this product, and they’ll help you pay for it. Think of this like a stamp of approval from insurance companies. As of July 2025, all Tamarasa Therapy Therapists are in-network with BCBS, Aetna, and Ambetter
Out of Network: An out-of-network provider, service, or prescription means insurance has NOT reviewed this person or thing prior to you using it, so insurance likely will not help pay for it. As of July 2025, we are Out of Network with MedCost, CBHA, BCBS Healthy Blue, Blue Home/Blue Local (UNC Alliance, Novant, Wake Forest), Medicaid or Medicare (any plans), and Tricare.
**If you have out-of-network benefits, you may be able to request reimbursement from your insurance for costs, utilizing a Superbill or using Thrizer.
Superbill: A superbill is like a mega-receipt that has your diagnosis, service, or prescription, and clinician information on it. You can submit these to your insurance company when you utilize an out-of-network service to see if insurance will help you pay for it.
**At Tamarasa Therapy, we’ve simplified the process of using your Out-of-Network (OON) insurance benefits. Instead of sending Superbills and having you navigate insurance claims on your own, we partner with a third-party service called Thrizer to handle that for you.
How it works: If you'd like to use your Out-of-Network benefits, we’ll start by setting up your Thrizer account together.
From there, here’s what to expect based on your specific insurance coverage:
If you haven’t met your deductible yet:
You’ll pay the full session fee up front. Once your claim is processed, Thrizer will reimburse you directly based on your insurance’s coverage.
If you’ve already met your deductible:
Thrizer will recognize this and adjust your payment so you only pay your co-insurance amount at the time of your appointment—not the full fee. This means you won’t have to wait for reimbursement later, saving you both time and money.
This system takes the stress out of dealing with insurance and helps you focus more on your care.
Sliding Scale: A sliding scale is what some therapy practices can offer for folks who do not have out-of-network benefits, do not have insurance at all, and cannot afford our out-of-pocket fees. A sliding scale is a reduced fee agreement with the practice. We have limited sliding scale availability with our clinicians. If needing to utilize a sliding scale, please contact our clinic coordinators to discuss and be informed of the proper steps.
Opting Out of Insurance: Many of our clients choose to opt out of using insurance, even when they have insurance we take. Folks choose to do this when they desire more data privacy and would prefer a diagnosis not be listed on their insurance record/file. If opting out of using insurance, we have a form you will need to sign. You legally cannot submit superbills for reimbursement if you have opted out of using insurance.
What to Know Before Enrolling in a New Health Plan
✅ Check if Your Current Providers Are In-Network
If you already have a trusted doctor, therapist, or medication that works well for you, it's very important to make sure those services are covered under your new insurance plan. Not all providers accept every insurance!
Before finalizing your new plan:
Ask your insurance agent to confirm whether your current clinician or prescriptions are in-network.
Use the insurance company’s provider directory. Search “[insurance plan name] + find a provider” to access the online directory for that plan.
Looking for Tamarasa Therapy’s Therapist?
You can search for our providers using their first and last names! If we appear in the directory, we’re in-network with that plan and able to provide services through your insurance.
Doing this step ahead of time helps ensure continuity of care—so you don’t lose access to the professionals and services that support your well-being.ealth insurance plan can feel overwhelming—especially with all the fine print and unfamiliar terms. It’s completely normal to feel unsure about what to look for. This section will guide you through some key factors to consider so you can choose a plan that truly meets your needs.
✅ Check to Be Sure the Plan Is a Good Fit Financially
The plan that’s best for you depends on your budget and what kinds of health services you and your family will use that year. Of course, we want you to pay as little as possible while still getting excellent care; however, it’s not always clear what the best choice on the marketplace is.
As mentioned earlier, you’ll notice there are plans with very low premiums, but that usually means high deductibles and high copayments. There are plans with very high premiums, but that may mean low or no deductibles and copays. Here is an example to clarify:
If you chose a plan with a $200 premium but with a high deductible of $5000 and 50% co-insurance, and chose to use our services once a week. Your payments would look like the following:
Premium payment: $200
Therapy sessions at $150 per session, 1x per week, for 4 weeks: $600.
Therefore: $200+$600 = $800 per month.
After 10 months, you meet the deductible and the 50% co-insurance kicks in. You now pay $75 per session.
At the end of the year, you’ve spent $9,000.
In this example, you have used no other services but weekly mental health therapy.
Now compare this to getting a PPO plan with a $400 premium and a $20 copay for therapy. The deductible doesn’t apply. For the same services, your payments would look like:
Premium payment: $400
Therapy sessions at $20 per session, 1x per week, for 4 weeks: $80.
Therefore: $400+$80 = $480.
At the end of the year, you’ve spent $5,760.
So even though the second plan has a higher premium, by the end of the year, you’ve saved $3,120.
Affordable Therapy Options
We understand that insurance can be a financial strain. At Tamarasa Therapy, we offer reduced-rate sessions with our highly trained clinical interns to make care more accessible.
Individual sessions: $37.50 (in-person or virtual)
Couples sessions: $40
Sliding scale available: As low as $30 per session for individual therapy
What we accept here at Tamarasa Therapy
Tamarasa Therapy is in-network with Ambetter, Aetna (including NC State Health Plan), BCBS NC, BCBS PPO plans, United Healthcare (some clinicians), and Cigna (some clinicians). We are not in-network with CBHA, MedCost, Blue Home, Blue Local, Tricare, Aetna EPO plans, or any Medicaid/Medicare plans (including Healthy Blue, Trillium, etc). The cost of your sessions can vary significantly depending on your specific plan.
Our goal is to provide quality, affordable support—without compromising on care.
If you have any questions about any of the above information or want to discuss new insurance plans, do not hesitate to reach out to our Clinic Coordinators, Alexis and Frances! Call or text - 919-228-8455 / Email - support@tamarasatherapy.org
