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  • Writer's pictureBeal Wellness Staff

Navigating Healthcare Costs: Emily’s Journey with Beal Wellness

Introduction: Understanding the intricacies of health insurance and out-of-pocket costs can be challenging. To help demystify this process, we are sharing a real-life example of a patient, Emily, who utilizes Beal Wellness for her healthcare needs. Emily is a young professional managing her anxiety with the support of our clinic, regular medication, and weekly therapy sessions. In this story, we’ll break down how her insurance works and what her financial responsibilities are.

Emily’s Health Insurance Plan: Emily has a Preferred Provider Organization (PPO) health insurance plan. Her plan has a $500 yearly deductible, a $30 copay for specialist visits, a $20 copay for primary care visits, a $15 copay for generic prescription medications, and a 20% coinsurance for therapy sessions. The plan’s out-of-pocket maximum is $3,000.

Monthly Medication Visits at Beal Wellness: Emily visits her psychiatrist at Beal Wellness once a month to manage her anxiety medication. Since her psychiatrist is considered a specialist, her copay for each visit is $30. Her generic anxiety medication has a $15 copay per month.

Weekly Therapy Sessions: In addition to her medication, Emily attends weekly therapy sessions to help manage her anxiety. With her insurance plan, she pays 20% of the cost of each session. If each therapy session costs $150, Emily’s coinsurance payment would be $30 per session.

Calculating Emily’s Costs: In a typical month, Emily’s healthcare costs look like this:

  • Psychiatrist visit: $30

  • Medication: $15

  • Weekly therapy sessions (4 sessions): $120 ($30 per session)

Total monthly cost: $165 Total annual cost: $1,980

Insurance Payments: Emily’s insurance covers the remaining cost of her visits and medication after her copays and coinsurance. Additionally, since Emily visits her psychiatrist and therapist regularly, she quickly meets her $500 deductible early in the year. After meeting her deductible, her insurance covers a larger portion of her therapy sessions, further reducing her out-of-pocket costs.

The Role of the Deductible and Out-of-Pocket Maximum: Once Emily meets her $500 deductible, her insurance starts to pay a larger share of her therapy session costs, reducing her coinsurance amount. If Emily’s healthcare needs increase throughout the year, her consistent payments toward her deductible and out-of-pocket costs ensure that she will never pay more than $3,000 out of pocket for her covered healthcare services.

Conclusion: Emily’s story illustrates how understanding your health insurance plan can empower you to better manage your healthcare costs. By choosing Beal Wellness for her mental health needs, Emily has found a supportive environment to manage her anxiety while navigating her financial responsibilities with clarity. Remember, taking the time to understand your insurance plan, deductible, and out-of-pocket maximum can help you make informed healthcare decisions and prevent unexpected financial surprises. At Beal Wellness, we are committed to providing comprehensive care and support to all our patients, helping them thrive both mentally and financially.

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