Billing You Can Actually Understand
A Patient Guide to Common Billing Terms & Questions
Brought to you by your care team & MB Strategy Group
We know insurance can feel overwhelming. That's why our team is here to walk you through every step — before, during, and after your visit. This guide explains the most common billing terms in plain, everyday language so you always know what to expect.
Understanding Your Insurance Coverage
Q: What is a deductible?
Your deductible is the amount you pay out of pocket for healthcare services before your insurance starts sharing the cost. For example, if your deductible is $1,500, you pay the first $1,500 of covered services yourself each year. After that, your insurance kicks in and helps cover the rest.
💡 Our team will check where you are in your deductible before your appointment so you know what to expect.
Q: What is a copay?
A copay is a fixed dollar amount you pay for a covered service — usually at the time of your visit. For example, you might have a $30 copay every time you see a specialist. Copays are straightforward and don't usually count toward your deductible.
💡 Always bring your insurance card to your appointment so we can confirm your copay amount.
Q: What is co-insurance?
Co-insurance is your share of costs after you've met your deductible — expressed as a percentage. If your co-insurance is 20%, that means your insurance pays 80% and you pay the remaining 20% of the bill. Co-insurance applies until you reach your out-of-pocket maximum for the year.
💡 Example: A $500 service with 20% co-insurance after your deductible = you owe $100, your insurance pays $400.
Q: What is an out-of-pocket maximum?
This is the most you'll have to pay for covered services in a plan year. Once you hit this limit, your insurance covers 100% of covered services for the rest of the year. It includes your deductible, copays, and co-insurance — but usually not your monthly premium.
💡 If you're close to your out-of-pocket maximum, certain treatments may cost you nothing. Ask us and we'll check!
In-Network vs. Out-of-Network
Q: What does 'in-network' mean?
In-network means our practice and providers have a contract with your insurance company. This means your insurance has agreed to pay a set rate for our services — which typically means lower costs for you. Always check that your provider is in-network before your visit.
Q: What does 'out-of-network' mean?
Out-of-network means a provider does not have a contract with your insurance company. Your insurance may still cover some of the cost, but usually at a lower rate — meaning you could owe more. Some plans don't cover out-of-network care at all.
💡 We will verify your network status before your appointment. If there are any concerns, we'll let you know upfront.
Coordination of Benefits (COB)
Q: What does COB (Coordination of Benefits) mean to me as a patient?
If you have more than one health insurance plan — for example, coverage through your employer AND through a spouse's employer — Coordination of Benefits (COB) is the process that determines which insurance pays first (the 'primary' plan) and which pays second (the 'secondary' plan). The goal is to make sure your total benefits don't exceed 100% of the actual cost of your care.
For example: Your primary insurance covers 80% of a bill. Your secondary insurance may then cover some or all of the remaining 20% — potentially leaving you with little or nothing to pay.
💡 Always let us know if you have more than one insurance plan. We'll handle the coordination so you're not overpaying.
Your Explanation of Benefits (EOB)
Q: What is an Explanation of Benefits (EOB)?
An EOB is a statement from your insurance company that explains what was billed, what they covered, and what you may owe. It is NOT a bill — it's a summary of how your claim was processed. You'll usually receive it by mail or through your insurance company's online portal after a visit.
💡 If anything on your EOB looks confusing, reach out to our billing team — we're happy to walk you through it line by line.
Prior Authorization & Coverage
Q: What is prior authorization?
Some treatments or medications require your insurance company to approve them before you receive care. This is called prior authorization (also called pre-authorization or pre-approval). Without it, your insurance may deny the claim or cover less of the cost.
💡 For specialized treatments like Spravato or TMS, our team handles prior authorization on your behalf before your first session.
Q: What if my insurance denies a claim?
If your insurance denies a claim, you have the right to appeal. Our billing team will work with you and your insurance company to review the denial and submit an appeal when appropriate. We advocate on your behalf — you don't have to navigate this alone.
Questions About Your Bill
Q: I received a bill — what do I do?
Don't panic! Review your Explanation of Benefits (EOB) from your insurance company and compare it to your bill. If anything doesn't match or you don't understand a charge, contact our billing team right away. We're here to help clarify every line item.
Q: What is a balance bill?
A balance bill is when a provider charges you the difference between their rate and what your insurance paid. Federal and state laws now protect patients from surprise balance billing in many situations — especially for emergency care. If you ever receive a bill that doesn't look right, contact us immediately.
Q: Can I set up a payment plan?
Yes. If you're having difficulty paying your balance, please reach out to our billing team. We understand that medical expenses can be unexpected, and we'll work with you to find a solution that fits your situation.
Have a billing question? We're here for you.
MB Strategy Group · Spravato & TMS Billing Specialists