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1295 Bandana Boulevard West
Suite 310 & 210
St. Paul, MN 55108
P: 651-645-5323
F: 651-621-8490
Toll-Free: 1-888-364-5977

Insurance Terms and Definitions

Insurance

Insurance terms and definitions

Health insurance basics

On this page, we try to explain a very complex issue in simple language.

A health insurance policy is a contract between an insurance company and an individual or a group of individuals, like an employer or labor union. Basically, you pay the insurance company a set amount of money during the contract period and, in return, the insurance company agrees to pay for a portion of your medical care. Since your policy is a contract, its terms determine what coverage you may or may not get.

To get the most from your health insurance, it’s important to understand some basic insurance terms and their definitions:


  • Claim:

    Paperwork submitted to the insurance company for services covered under your policy. In-network providers usually handle the claims paperwork for you.

  • Coinsurance:

    The percentage you pay for services; often the percentage of your responsibility after the deductible has been satisfied. This is usually in lieu of a co-payment, but can sometimes be in addition to a co-payment. This will be determined by the contract you have with the insurance company. For example, you might have to pay 20% of the cost of a surgery, while the insurance company pays the other 80%. You could end up owing very little or a great deal, depending on how much care you get in a year and your policy’s upper limit on coinsurance (called an “out-of-pocket maximum”).

  • Co-payment (aka co-pays):

    The dollar amount you must pay “out of pocket” before the health insurer pays for a particular visit or service. For example, your insurer might require a $30 co-payment for each appointment with your Veritas Collaborative therapist, while your insurance company pays the rest of the fee for that visit. Co-pays are due at the time of service and may not contribute to the overall out-of-pocket maximum.

  • Deductible:

    A fixed dollar amount you pay during the benefit period (usually a year) before the insurer starts to make payments for covered medical services. Plans may have both per individual and family deductibles.

    • Some plans may have separate deductibles for specific services. For example, a plan may have a hospitalization deductible per admission.
    • Deductibles may differ if you get services from an in-network provider or out-of-network provider.

    It’s easy to get the deductible confused with the co-pay or co-insurance, but they are different things. Let’s say your policy has a $500 deductible per year. If each trip to one of your healthcare providers costs $250, then you must pay the full amount for the first 2 visits before the insurance company starts paying for your future visits.

  • Coverage limits:

    Some health insurance policies only pay for healthcare up to a certain dollar amount (e.g. $500,000 or $1,000,000) for all of your healthcare or for a specific service. For example, many insurance policies have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when the benefit maximum is reached, and you must pay all the remaining costs.

  • Exclusions:

    Your insurance may not pay for every healthcare service you need. Exclusions are the services that are not covered. Generally, you’re expected to pay the full cost of “excluded” or non-covered services.

  • Explanation of Benefits (EOB):

    When you receive a healthcare service and the claim has been processed, the insurance company will often send you a document explaining how the claims for services were processed and any services that were not covered.

  • In-Network Provider/Contracted Provider:

    Most health insurance companies contract with healthcare providers who sign a contract with the insurer. Generally, in-network providers agree to accept “discounted” rates for services. The client co-pay and/or coinsurance will be based on this amount. An insurer may also contract with specific providers because of their success rate, quality of care, and/or other factors.

  • Insurance Policy:

    Another term for the contract you sign with the insurance company. Most health insurance policies are many pages long with a lot of fine print. As a practical matter, few of us need to read all of the fine print. But if you are struggling to get your insurer to pay for certain services—like eating disorders treatment—you will need to know your policy (including the fine print) well. 

  • Insurance Regulation:

    The individual states have primary responsibility for most health insurance companies and their practices. State legislatures write the laws and a state agency enforces them. Each state has a Commerce or Commissioner who oversees health insurance companies. Federal statutes—such as laws for healthcare reform and mental health parity—also govern some insurance practices.

  • Out-of-Network Coverage:

    If your insurance company is not contracted with a healthcare provider, you will typically pay a higher out-of-pocket cost for services.

  • Out-of-Pocket:

    The money you pay from your own funds (that is, out of your pocket) for a healthcare service, even though you have health insurance. Some common “out-of-pocket” expenses are co-pays, coinsurance, and deductibles. Important: The same insurance policy may have a co-pay for some services and deductible for different services—it all depends on the details of your health insurance policy/contract.

  • Out-of-Pocket Maximums:

    The highest dollar amount your insurance policy requires you to pay out-of-pocket for covered services in a year. Let’s say your policy’s in-network out-of-pocket maximum is $1,000 a year; once you spend $1,000 out-of-pocket, you may not have to pay anything else out-of-pocket—unless you exceed the coverage limits or receive care at an out-of-network provider. Depending on your policy, some costs you pay do not apply to the out-of-pocket maximum. As usual, these issues are determined by your insurance company.

  • Premium (aka Rate):

    The amount of money that you or your group (e.g., an employer, labor union) pays to the insurance company to purchase health coverage.

  • Prior Authorization:

    Before agreeing to pay for a certain service or procedure, an insurance company may require you to get permission in advance—prior authorization—for it. Many less expensive, routine services—like a physician’s visit for strep throat—may not require prior authorization. An insurer is more likely to require prior authorization for more expensive, complex, and long-term care—like residential eating disorders treatment.

    The insurer usually requires the provider to produce documents and other data to prove that the proposed treatment is “medically necessary.” Some insurers use complex criteria in order to grant a prior authorization and may refuse to reveal the criteria they used to determine if a particular course of treatment can be covered. (Remember, though, that a “medically necessary” treatment still won’t be covered if your insurance policy doesn’t include it among the services covered under your benefits.) Since eating disorders treatment can take a long time, The Emily Program may run into authorization challenges. Fortunately, we have good working relationships with most insurers, and can often agree with them on a course of action.


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What Will Your Insurance Pay

Insurance

What will your insurance pay?

Step one: Call your insurance provider

You and your loved ones are the best advocates for your own benefits. Veritas Collaborative will contact your insurance company for a general quote of benefits after scheduling your intake appointment, but to determine how much of the cost of your care you are responsible for, you must contact your insurance provider personally.

Our insurance verification tool will help guide you through this conversation. This tool includes everything you will need to have ready for the phone call to your insurance company to get an estimate of your insurance benefits while you are at Veritas Collaborative.

If you continue to have trouble receiving adequate coverage from your insurance company or if you’re unclear on the terminology, please read our:

If you are unable to get the information you need, another option is to call your insurance company’s ‘Health Advocate’ or ‘Case Manager’ department. These insurance representatives are dedicated to helping you understand and navigate your benefits. (Look for a phone number or other contact information on the back of your insurance card.)

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Health Insurance FAQs

Insurance

Health Insurance FAQs

  • What is Veritas Collaborative’s stance on insurance coverage for the cost of eating disorder treatment?

    Veritas Collaborative partners with numerous insurance plans to make our care accessible to as many individuals as possible.

  • Does Veritas Collaborative accept all insurance providers for covering the cost of eating disorder treatment?

    We have partnerships with a wide range of insurance providers. If your provider is not listed on our website, we may still be able to work with them to create a single-case agreement tailored to your needs. Please contact our admissions team so that we can provide the most accurate information for your particular situation.

  • What is a single-case agreement?

    A single-case agreement is a one-time contract between Veritas Collaborative and an insurance provider that is not part of our regular network. This agreement allows us to provide care for a specific individual even if their insurance is not typically accepted.

  • How does Veritas Collaborative work with insurance plans regarding the average cost of eating disorder treatment?

    We work closely with insurance plans at every stage of the recovery journey. Our goal is to ensure that every individual receives the right care at the right time for as long as they need it.

  • Are the listed insurance partners on the website always up-to-date for covering the cost of eating disorder treatment?

    While we try to keep all of our insurance partners and benefits up to date, these can change over time. For the most current information on providers, plans, and coverage, contact your insurance provider. Our Insurance Verification Tool is designed to help you navigate that conversation.

  • Is there a difference in insurance coverage for children and adolescents when considering the cost of eating disorder treatment?

    Yes, certain insurance options, like Medicaid, are available only for children and adolescents. It’s essential to check the specific details for each insurance provider.

  • What is the average cost of eating disorder treatment at Veritas Collaborative?

    The average cost of eating disorder treatment can vary based on several factors, including the type of disorder, the severity of the condition, and the chosen treatment program. While we strive to make our care accessible, it’s essential to understand that costs can differ. For a more detailed estimate tailored to your situation, we recommend consulting with your insurance provider for further details.

  • What should I do if my insurance provider is not listed on the website, but I’m concerned about the average cost of eating disorder treatment?

    If your insurance provider is not listed, don’t hesitate to contact us. We may still be able to create a single-case agreement to accommodate your needs and provide clarity on costs.


For additional questions and information regarding your benefits, please contact the Customer Service Line on the back of your insurance card.

Please call Veritas Collaborative’s Client Accounts Team with questions regarding the services you have received, clarification on your statement, and payment plan options: 1-888-364-5977, ext. 1357.


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Current Insurance Providers

Insurance

Current Insurance Providers

We currently partner with the insurance providers below. If yours is not listed we may be able to work with your provider to create a single-case agreement and a care plan that’s right for you.

  • Aetna logo

    Aetna

    Nationwide Access to All Programs in All Locations

  • Anthem / BCBS logo

    Anthem / BCBS

    Nationwide Access to All Programs via “The Suitcase”

  • Cigna logo

    Cigna

    Nationwide Access to All Programs

  • ComPsych logo

    ComPsych

    Nationwide Access to All Programs in All Locations

  • Humana logo

    Humana

    Nationwide Access to All Programs in All Locations

  • Kaiser Permanente logo

    Kaiser

    Nationwide Access to All Programs in GA

  • Magellan Health logo

    Magellan Health

    Nationwide Access to All Programs in All Locations

  • Medicaid.gov logo

    Medicaid

    (available only for children and adolescents) — TennCare / CMO Only in GA

  • MultiPlan logo

    MultiPlan

    Nationwide Access to All Programs in All Locations

  • UnitedHealthcare Optum logo

    United Healthcare | Optum

    Nationwide Access to All Programs in All Locations

  • Stethoscope

    Other Insurance Companies

    Success with Single Case Agreements

Insurance partners and benefits are subject to change. Call us at 855-875-5812 for the most up-to-date information on providers, plans, and coverage.

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Insurance Coverage

Insurance Coverage

We’ll help you get the right care.

Removing barriers to treatment is central to the Veritas mission, and that includes financial barriers. We partner with a wide range of insurance plans to make our care accessible to as many people as possible, and we work closely with those plans, at every stage of the recovery journey, to help every individual get the right care at the right time, for as long as they need it.

Call 855-875-5812 to get help with an eating disorder.

Understanding the Cost of Eating Disorder Treatment

At Veritas Collaborative, we recognize that one of the primary concerns for many individuals and their families is understanding the average cost of eating disorder treatment.

The journey to recovery is deeply personal, and the cost of eating disorder treatment can vary widely based on several factors. These include the type of disorder, the severity of the condition, the duration of the treatment, and the specific program chosen. For instance, the cost of inpatient or residential treatment at one of our eating disorder treatment centers will differ from outpatient treatment.

While we strive to provide clarity on how much eating disorder treatment costs, it’s essential to note that every individual’s journey is unique. This means that the average cost of eating disorder treatment can differ based on personalized care plans tailored to each individual’s needs.

We’re proud to partner with a wide range of insurance providers to help alleviate these costs. Our goal is to make our top-tier care accessible to as many individuals as possible, so financial barriers don’t stand in the way of recovery.

If you have specific questions about the cost of eating disorder treatment at Veritas Collaborative, we encourage you to reach out to our admissions team. We will contact your insurance company for a general quote of benefits after scheduling your intake appointment, but to determine how much of the cost you are responsible for, you must contact your insurance provider personally. Our Insurance Verification Tool will guide you through this conversation.

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