Kelsey Someliana-Lauer MA, LCMHCA
Health insurance can feel confusing and overwhelming, especially when you’re trying to understand all the different words, options, and costs involved! Whether you’re new to choosing a plan or looking to switch, it’s normal to have questions about what terms like deductible or copay really mean and what kind of plan will work best for you.
Origins Counseling & Wellness is here to guide you through the basics of insurance language, what to think about when picking a plan, and how to decide which option fits your needs. We want you to feel confident and empowered in making healthcare choices that support your well-being.
As we get ready to enter into open enrollment for 2026, we want you to navigate these waters confidently without risking lost coverage of your therapist or other professional services you utilize!
Know Your Insurance Lingo
Understanding health insurance can feel like learning a whole new language, and you’re not alone if it’s confusing. Words like deductible, copay, and network can make it hard to know what you’re really paying for. Let’s break down some of the most common terms so you can feel more confident and informed.
Copay: a copayment is a flat fee you pay when using a healthcare service or purchasing prescriptions. 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 (AKA sharing costs). 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 will be different at different offices, even if they’re the same type of doctor, because insurance sets a different price for different physicians. For example, your deductible payment at Origins Counseling & Wellness might be $120.15 (an example number), but at another office in Greenville NC, it may be higher or lower.
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 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 this 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, it will save time and money to see someone who can accept your insurance.
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, we are in-network providers for BCBS, Aetna, and United insurances.
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 Cigna, Medcost, TriCare, CBHA, Medicare/Medicaid, and some closed-network BCBS plans.
**If you have out of network benefits, you may be able to request reimbursement from your insurance for costs, utilizing a Superbill**
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.
- If you have an insurance we do not take, and want to pursue using your out of network benefits, here is how that works:
- You pay us our full out of pocket rate (Currently $205 for the first intake session, and $200 for other sessions)
- We send you a monthly Superbill automatically to the email you have on file
- You download that Superbill and then send this to your health insurance company
- Most companies make this pretty easy, you can usually submit it online through their website or within a portal.
- Then if you have out of network benefits, your insurance company reimburses you directly for services.
- Some insurance reimburse 80% for example, so for each $200 session, they would reimburse you $160. Effectively making your therapy rate $40 after the reimbursement! (Woohoo!)
- Please note that some insurances refuse to cover out-of-network benefits, or require a separate out-of-network deductible.
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 your clinician or our billing department to discuss. You cannot legally submit superbills for reimbursement on reduced fee sessions.
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.
Enrolling In A New Insurance Plan
Choosing a new health insurance plan can feel overwhelming, especially when every option seems to come with fine print and confusing details. It’s totally normal to feel unsure about what to look for. This section will walk you through some key things to look for so you can pick a plan that actually works for you.
Checking network status of your current providers: if you already have a doctor, clinician, or medical prescription that you really like, it’s very important to check if they’re in-network with your new insurance plan. Not every doctor can take every type of insurance! Before you purchase a new insurance plan, ask an insurance agent to check if your clinician or prescription is in-network with the new plan. You can also use an internet search listing “insurance plan” + “find a provider” to find the directory for your specific plan. You can search for us by utilizing the NPI 1811537202 for Leah Riddell. If listed, then we are in-network and able to assist you, utilizing your insurance!
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.
Deductible amount: as we talked about earlier, the deductible amount is the amount you’ll have to pay before insurance begins helping you out, if you don’t have copays. The premium is NOT included in this, so keep in mind you’ll be paying a monthly premium PLUS the entire deductible amount. A high deductible can mean pricey services, but may not be an issue if you very infrequently use services.
If you choose a high deductible plan of $5000, with a monthly premium of $200, and utilize our services 1x weekly, your monthly costs could look like this:
- Premium payment: $200
- Therapy sessions at $125 per session, 1x per week, for 4 weeks: $500.
- Therefore: $200+$500 = $700. So this plan choice may or may not save you money depending on your usage, and it may be more cost effective to pay a higher premium for a copay plan with low or no deductible.
- In this example, if you see no other professionals but us, you would need to pay $500 a month in deductible payments for 10 months, before insurance could kick in and help cover costs.
- In this example, if you see no other professionals but us, you would need to pay $500 a month in deductible payments for 10 months, before insurance could kick in and help cover costs.
Expenditures for commonly used services: One of the most important things to check is the benefits package for your insurance plan. Your benefits package will list prices for prescriptions, for emergency room and doctor’s office visits, for mental health therapy, and more. Check the price of your most commonly used services to see if it’s affordable. For example, if you know you attend therapy weekly, you may want an insurance plan with a low copayment for outpatient mental health therapy.
Check out an example of a benefits package here.
Which Insurance Company Should I Look At:
Choosing the right health insurance plan can feel tricky because there are so many options and details to consider. The best plan for you depends on your health needs, budget, and how you like to get care. In this section, we’ll help you think through the most important things to look for so you can pick a plan that fits your life. Origins only accepts BCBS, Aetna, and UnitedHealthcare plans. UnitedHealthCare also limits providers to only certain licenses, so if you are thinking of utilizing a UHC plan, check with your specific provider to see if they are covered!
Network: Around 92-96% of medical providers in NC accept BCBS, making it a very popular insurance plan.
Premium amounts: these tend to be moderate to high comparatively, with many plans starting around $250 monthly for the least amount of coverage.
Deductibles and copays: BCBS carries a range of plans, including some high deductible plans with lower premiums, and some with copays of $0 but lower premiums.
Network: Aetna does not specify the percentage of providers that accept Aetna; it is likely comparable, albeit slightly less, than BCBS across North Carolina.
Premium amounts: the average premium payment for Aetna is $350 monthly.
Deductibles and copays: Aetna also carries a range of plans, including plans with high deductibles, low deductibles, and copay amounts.
Network: United Healthcare does not specify the percentage of providers that accept their plan; however, UHC is one of the largest insurance plan providers in the US.
Premium amounts: the average premium payment for UHC is $600 monthly when purchased on the ACA.
Deductibles and copays: United Healthcare, like the others, has a range of plans. You can expect a deductible payment of $1,500 – $7,500 for most UHC plans.
Network: Cigna does not specify their network in NC; however, out of the plans listed in this blog post, Cigna is the least accepted by providers across NC.
Premium amounts: the average premium payment for Cigna is $600 monthly.
Deductibles and copays: United Healthcare, like the others, has a range of plans. You can expect a deductible payment of $1,500 – $7,500 for most UHC plans.
At Origins Counseling & Wellness, we accept BCBS, Aetna, and UnitedHealthCare PPO plans to make mental health care accessible and easy to navigate. If you have questions about insurance or need help figuring out your coverage, our friendly front staff is always here to assist. Your mental health matters to us, and we’re committed to supporting you every step of the way.