Understand your family’s share of the cost

Your insurance plan may include a deductible, a copayment, or coinsurance. Understanding these terms helps you plan for your child’s care.

Funding Options May Be Available

Eligible families may be able to use Step Up for Students scholarship funding to help cover approved ABA deductibles and copayments. Sunshine receives direct payment from Step Up for approved expenses.

If costs are a concern, contact Sunshine billing early to discuss whether funding may be available for your family and how to coordinate payment. Eligibility, available funds, and expense approval determine what can be covered.

Visit the Step Up for Students section in this portal to learn more.

What is a deductible?

A deductible is the amount you pay for covered services that apply to your deductible before your insurance begins sharing those costs. It usually resets each plan year.

Example: Your deductible is $2,000 and $1,500 has already been counted toward it. You have $500 left to meet. After you meet it, copayments or coinsurance may still apply.

Some covered services may be paid before you meet your deductible. Your plan may also have separate individual and family deductible rules.

What is a copayment?

A copayment, often called a copay, is a fixed dollar amount you pay for a covered service.

Example: If your plan has a $30 copay for a particular covered service, your copay for that service is $30. The amount and when it applies depend on your plan and the service.

What is coinsurance?

Coinsurance is a percentage of the insurance plan’s allowed amount for a covered service that you pay, generally after meeting your deductible. The allowed amount is the price your plan recognizes for that service.

Example: After your deductible is met, your plan has 20% coinsurance. If the allowed amount is $200, your share is $40 and your insurance pays the remaining $160.

Remember the difference

Deductible: an amount you meet before your plan starts sharing certain costs.
Copayment: a fixed dollar amount for a covered service.
Coinsurance: a percentage of the allowed amount.

These examples explain the terms; they are not Sunshine’s rates or an estimate of your bill. Your plan determines which costs apply. You do not necessarily pay all three for every service.

Get your estimate explained

Ask Sunshine billing to explain your estimated responsibility in writing, what remains on your deductible, and whether your ABA services have a copay or coinsurance. Estimates can differ from your insurer’s final claim processing.

Understand the documents

An insurance explanation of benefits describes how a claim was processed; it is not itself a provider bill. Ask billing to help reconcile it with your statement.

Different services may appear

Direct therapy, BCBA services, assessments, and caregiver training may appear separately. Ask billing what each line represents.

Notify us of insurance changes

Tell your established billing contact promptly when coverage changes. Before an upcoming plan year, ask how a benefit or deductible reset could affect costs.

Questions about your bill?

Contact Sunshine billing at lrael@sunshineautism.com for help with your family’s account. Use your established secure billing channel for account documents.

Definitions: Deductible · Copayment · Coinsurance (HealthCare.gov).