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 ?
Because many illnesses such as cancer, MS, hemophilia, and rheumatoid arthritis are treated with expensive, specialty drugs, several patient support groups and some drug manufacturers offer cost-sharing programs and "co-pay assistance" cards that cover a portion of their prescription costs.
"It is the responsibility of the hospital to orient patients about the PhilHealth's new scheme upon admission and to post list of Medical Cases that will subject to the Fixed Co-Pay," Abadu said.
The Octapharma Co-Pay Assistance Program is available to primary humoral immunodeficiency patients who are currently receiving Octagam Immune Globulin Intravenous (Human) 5% Liquid Preparation or have a prescription to begin therapy; and those age 18 or older with chronic immune thrombocytopenic purpura who are currently receiving Octagam Immune Globulin Intravenous (Human) 10% Liquid Preparation or have a prescription to begin therapy.
That might involve getting a manufacturer's so-called co-pay card for a patient, helping an eligible Medicare patient receive free medication from a drug maker or expediting the delivery of medication.
The majority of co-pay card programs fall short of the expected return on investment (ROI), because they are not tracked or monitored to the degree and frequency that they could be, they said.
Only 62 percent of the workers in plans that cover more than 1,000 employees have to pay a co-pay for an in-network office visit, but 35 percent have to pay a coinsurance amount.
The 2014 Medicare Part A inpatient hospital deductible is $1,216 per hospitalization and the co-pay for hospitalizations longer than 60 days is $304 per day.
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 ambulance service can bill her for the co-pay, which it admits to not having tried.
Many pharmacies are required under contract with pharmacy benefits managers to run prescriptions through consumers' insurance regardless of whether or not the co-pay is higher than the retail price.
According to the committee, charging patients a 20% co-pay for lab work would save Medicare $23 billion over ten years.
The legislation phases out the discriminatory 50% co-pay for mental health ambulatory care under Medicare Part B over 6 years.