When a member adds their insurance to Tava, we provide an estimate of what they will likely owe for each therapy session so they have a clearer picture of cost before getting started.
| Important: This estimate is not a bill or a guarantee of the member’s final responsibility. The actual amount a member owes is determined by their insurance company after the claim is processed. In most cases, the estimate is close to the final amount, and Tava aims to make it as accurate as possible. |
How Insurance Billing Works at Tava
When a member joins Tava using insurance, here's what happens:
- The member or care navigator enters their insurance information during intake.
- Tava verifies their benefits directly with their insurance company — including their deductible status, copay or coinsurance, and remaining out-of-pocket maximum.
- Tava determines the contracted rate between the insurer and their provider.
- The member's cost is calculated based on their plan structure:
- If they've met their out-of-pocket maximum: They owe $0.
- If their plan has a copay: They pay a flat fee per session (e.g., $30).
- If their plan has a deductible and coinsurance: They pay the full contracted rate until their deductible is met, then their coinsurance percentage (e.g., 20%) after that.
- Members are not charged until after a session is completed and the claim is processed.
Why the final cost may differ from the estimate
Estimates are based on the best information available at the time they are generated, but a few things can affect the final amount.
Timing of other claims: An estimate reflects benefits at a specific point in time. If the member has other medical claims processed after the estimate is created but before the therapy claim is billed, their deductible or out-of-pocket balance may change.
Mid-year plan changes: If the member changes insurance plans, their benefits may change as well. The estimate may not reflect that new plan until benefits are re-verified.
Claim processing rules: In some cases, the insurance company may process the claim differently than what was reported during the benefits check.
Coordination of benefits: If the member has more than one insurance plan, the way those plans coordinate payment can affect the final amount owed.
If a member wants a specific estimate before signing up, direct them to:
- The member services number on the back of their insurance card
- Their insurance company's online member portal