How we estimate session costs

When a member adds their insurance to Tava Health, 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.

How Insurance Billing Works at Tava Health

When a member joins Tava using insurance, here's what happens:

1. The member or care navigator enters their insurance information during intake.
2. Tava verifies their benefits directly with their insurance company — including their deductible status, copay or coinsurance, and remaining out-of-pocket maximum.
3. Tava determines the contracted rate between the insurer and their provider.
4. 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.
5. Members are not charged until after a session is completed and the claim is processed.

What members should know

A cost estimate is an informational preview of what a member may owe for a session using their insurance. It is not a bill or a guarantee. The final amount is determined when the insurance company processes the claim after the session.

Tava Health uses the member's insurance information to create the best estimate possible. Depending on the information Tava Health receives from the member’s health plan or insurance, a member may see a single dollar amount, a dollar range, or no estimate available.

What a member may see

1. A single estimated cost

When Tava Health receives a strong estimate, the member sees one estimated per-session amount. For example, “With your insurance, we expect therapy  to cost $50 per session.”

Figure 1 below shows an example of a single estimated per-session cost during intake.

At scheduling, that single estimated amount may also appear next to the member’s selected insurance coverage and in the estimated total.

Figure 2 below shows an example of a single estimated total when insurance is selected at scheduling.

2. An estimated cost range

When Tava Health receives an estimate but the exact amount is less certain, the member sees a range. For example, “With your insurance, Tava estimates between $25–$35 per session.”

Figure 3 below shows an example of a range during intake.

Figure 4 below shows how a range may appear when a member selects insurance during scheduling.

3. Insurance verified, but no estimate is available

Sometimes Tava Health can verify a member’s insurance but does not have enough information to provide a reliable cost estimate. In this case, the member may see that their policy is verified without a dollar amount.

Figure 5 below shows an example of a verified policy with no estimate shown.

At scheduling, the insurance line may show “Unconfirmed.” This means Tava Health cannot provide a reliable personalized estimate at this time. It does not mean the member’s insurance is not verified, and it does not determine the member’s final bill. The dollar amount shown in this case is the estimated cash pay rate. 

We’re continuing to improve how we present cost information when a personalized insurance estimate isn’t available. In the meantime, members can contact their insurance provider for the most current information about their expected cost.

Figure 6 below shows an example of this scheduling state.

A note for members with sponsored sessions

During intake, members who have sponsored sessions may see that their insurance policy is verified, not an out-of-pocket estimate. This helps avoid confusion when their benefit is covering their sessions. If they later select insurance coverage for a session, they may see one of the estimated experiences above during scheduling.

How care navigators can help

• Reinforce that the number is an estimate, not a final bill.
• Explain that a single amount or range gives the member an early view of their potential cost.
• If the member sees “Unconfirmed,” clarify that Tava could not provide a reliable estimate yet; it does not mean insurance verification failed.
• For the most current information about benefits or expected responsibility, direct the member to the member services number on the back of their insurance card or their insurer’s member portal.
• If the member has a question about a charge after a claim is processed, direct them to Tava Support at client.support@tavahealth.com for help reviewing the charge.
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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