Insurance FAQ
Frequently Asked Questions.
Primary insurance is the initial insurance policy billed by healthcare providers. It is determined based on specific rules related to your child’s insurance coverage.
A deductible is an annual amount you must pay for medical expenses before your insurance coverage begins for all medical benefits.
An out-of-pocket maximum is the most you pay annually for healthcare expenses before your insurance covers 100% of costs.
A copay is a fixed amount you pay for specific healthcare services at the time of service until reaching your out-of-pocket maximum.
Coinsurance is a percentage of the cost of services you pay after your deductible is met, instead of a fixed copay amount.
In-network providers have contracts with your insurance, offering lower rates. Out-of-network providers lack such contracts, often leading to higher costs.
Apple ABA assists families in understanding and navigating insurance coverage, working to maximize benefits and access necessary ABA therapy services.
An SCA is a contract between your insurance and an out-of-network provider, allowing coverage for services when in-network options are unavailable.
Providers must have an agreement with your insurance to accept coverage. Establishing such agreements can be lengthy, taking up to two years.
If no providers accept your insurance, explore options like SCAs, Medicaid, or advocacy groups to find suitable coverage and care for your child.
