What it costs, and how insurance works

The short version

Money is the question people are most embarrassed to ask and most need answered. It is a fair question, and it deserves a plain answer.

Call and ask. Nexa will check your benefits by phone and tell you what it finds before you commit to anything. There is no charge for that call. A benefits check tells you what your plan says it will cover. It is not a guarantee of payment.

Prices are not posted here. Call Nexa at (805) 210-2288 and we will go through them with you.

If you have insurance

Call and we will check your plan. Nexa does not accept Medi-Cal or Medicare. Whether Nexa is in network with your plan, and what that means for what you pay, is what the benefits check finds out. Out of network does not always mean you pay the whole bill.

What to have ready when you call: your insurance card, the member ID and group number on it, and a rough sense of what has been going on.

Insurance, translated

Insurance has its own dialect, and nobody teaches it to you until you are already stressed. Here is the phrasebook.

• Deductible. What you pay each year before your plan starts paying its share.
• Copay. A flat amount you pay per visit or per day of care.
• Coinsurance. Your percentage of the bill once the deductible is met. If the plan pays 80 percent, the other 20 is yours.
• Out-of-pocket maximum. The ceiling on what you pay in a year for covered care. Past it, the plan pays the rest. Out-of-network care often has its own, higher ceiling, or none.
• In network, out of network. Whether a provider has a signed contract with your plan. It changes the price, not the care.
• Prior authorization. The plan's permission slip. Programs like the Partial Hospitalization Program (PHP) and the Intensive Outpatient Program (IOP) usually need one, and it is normally the program, not you, that asks for it.
• Explanation of Benefits. The statement your plan mails after a claim. It is not a bill, though it does its best to look like one.

You do not have to memorize any of that. Whoever answers the phone should be able to walk you through your own plan in plain English. If something is still unclear, ask again.

If you are covered under someone else's plan, the plan's statements usually go to the policyholder. Ask about that on your first call.

If you do not have insurance, or you are not using it

Call, and we will talk through the options with you. Whatever you settle on is quoted to you in writing before you start.

You also have the right to a Good Faith Estimate — a written estimate of what your care will cost, before it starts. Ask on your first call. Your full billing rights are here, including your protections against surprise bills.

What Nexa will not do

• Start treatment before you know what it costs.
• Change the price it quoted you in writing after you have started.
• Ask for health or insurance details through this website.

What your plan pays is your plan's decision, not Nexa's. Any estimate Nexa gives you says so.