Copayment

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Copayment

In insurance, a fee that a policyholder must pay for certain covered items for which the insurance company otherwise pays. For example, a check-up with a doctor may cost the policyholder a copayment of $25, with the insurance company paying for the remainder of the cost due. A copayment is also called a co-pay and should not be confused with a deductible. It exists to discourage policyholders from abusing the insurance policy.

Copayment.

If you have a managed-care health insurance plan, your copayment is the fixed amount you pay -- often $10 to $25 -- for each in-network doctor's office visit or approved medical treatment

In some plans, the copayment to see a specialist to whom you're referred is higher than the copayment to visit your primary care physician. Some plans may not require copayments for annual physicals and certain diagnostic tests.

If you see an out-of-network provider, you are likely to be responsible for a percentage of the approved charge, called coinsurance, plus any amount above the approved charge.

References in periodicals archive ?
SilverScript Choice is a basic plan that offers comprehensive coverage with competitive premiums, $0 deductible on all covered drugs in 47 states, and $0 co-pays for 90-day supplies of Tier 1 drugs nationwide when filled through the CVS Caremark Mail Service Pharmacy.
Co-pays are required for doctor prescriptions and in- and out-patient visits.
Managed care services company WellCare Health Plans (NYSE:WCG) said on Friday that it is eliminating co-pays for primary care physician visits and other medical care services for its South Carolina Medicaid members effective 1 November 2015.
The co-pays for primary care provider visits will vary based on the member s plan.
Co-pays that inhibit preventive consultations diminish the chance of a healthy life.
About 66 percent of private-sector employees must pay a co-pay for typical in-network office visits, and 27 percent must pay a coinsurance amount for an office visit.
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Thanks to the new health care law, women are guaranteed coverage without co-pays for annual well-women visits, contraception, contraceptive counseling, breastfeeding counseling and equipment, and HIV counseling and testing.
The same problem exists for emergency room co-pays. The average emergency room visit involves a co-pay of $76, which might not be high enough to dissuade plan participants from visiting emergency rooms for problems better solved elsewhere.
The RxCut[R] price on 21 of the 25 most frequently processed generic prescriptions, for their members, has been lower than an insurance co-pay of $10 or more.
According to the committee, charging patients a 20% co-pay for lab work would save Medicare $23 billion over ten years.
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