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Insurance Benefits Plain-Language Translator

See how plan numbers play out across a typical IOP episode — a teaching aid, not a price quote.

Illustration, not a quote. Don't enter any identifying info — runs entirely in your browser. Nothing is saved or sent.

Plan numbers

Deductible ($)

Already paid toward deductible ($)

Coinsurance after deductible (%)

Copay per visit ($)

How does the copay apply?

Out-of-pocket max ($)

Already paid toward OOP max ($)

Allowed amount per session ($)

Illustrative only. Real negotiated rates vary widely.

Sessions in the example episode

Default: 3 sessions/week × 6 weeks. A common IOP shape — not a clinical recommendation.

Illustration — not a quote, not a bill

With the inputs on the left, the worked example below would total a patient share of about $3,480 across 18 sessions at $300allowed each. Real numbers depend on the actual plan, the provider's contracted rate, what the plan covers, prior authorization, and other rules this tool doesn't know.

Plan pays

$1,920

Deductible met at

Session #10

OOP max reached at

Not in this episode

Total allowed billed

$5,400

What happens, session by session

For sessions 1 through 10, you are paying the full allowed amount yourself until the deductible is met. From session 11 through 18, you pay 20% coinsurance on each session's allowed amount.

Session	Allowed	To deductible	Coinsurance	Copay	Patient share	Running total
#1	$300	$300	$0	$0	$300	$300
#2	$300	$300	$0	$0	$300	$600
#3	$300	$300	$0	$0	$300	$900
#4	$300	$300	$0	$0	$300	$1,200
#5	$300	$300	$0	$0	$300	$1,500
#6	$300	$300	$0	$0	$300	$1,800
#7	$300	$300	$0	$0	$300	$2,100
#8	$300	$300	$0	$0	$300	$2,400
#9	$300	$300	$0	$0	$300	$2,700
#10	$300	$300	$0	$0	$300	$3,000
#11	$300	$0	$60	$0	$60	$3,060
#12	$300	$0	$60	$0	$60	$3,120
#13	$300	$0	$60	$0	$60	$3,180
#14	$300	$0	$60	$0	$60	$3,240
#15	$300	$0	$60	$0	$60	$3,300
#16	$300	$0	$60	$0	$60	$3,360
#17	$300	$0	$60	$0	$60	$3,420
#18	$300	$0	$60	$0	$60	$3,480

What this does NOT include

Monthly premium. Out-of-network charges and possible balance billing. Services the plan doesn't cover. Prior-authorization denials. Prior balances. Separate behavioral-health deductibles some plans still have. Family vs. individual deductible interactions. Tax-advantaged account (HSA/FSA) effects. Anything specific to a provider's contract with the insurer.

Deductible

The amount the patient pays before the plan starts paying its share for covered services in a plan year.

Coinsurance

Your share of each bill after the deductible is met, written as a percentage (e.g., you pay 20%, the plan pays 80%).

Copay

A flat dollar amount per visit. Depending on the plan, it can apply before the deductible, after it, or instead of coinsurance.

Out-of-pocket max

The yearly ceiling on what you pay for covered, in-network services. Once you hit it, the plan covers 100% for the rest of the year.

Allowed amount

The price your insurer and your provider have agreed on. Your share is calculated from this number, not from the provider's list price.

Illustrative, not a quote, plan-specific.The headline number is an example built from the inputs you typed — not what anyone will actually owe. Real costs depend on the specific plan, the provider's contracted rates, coverage, prior authorization, and other plan rules. For an actual estimate, call the member services number on the back of the insurance card and the provider's billing office, and read the plan's Summary of Benefits and Coverage (SBC). This tool provides general educational information about how health insurance arithmetic works. It is not medical, legal, billing, or financial advice. It does not communicate with any insurer. Definitions follow the federal plain-language glossary at healthcare.gov/glossary/.