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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.


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 ?
If CRN occurs primarily among high-comorbidity patients, then it may be cost-effective to reduce copayments for these individuals following the principles of value-based insurance design (Chernew, Rosen, and Fendrick 2007; Chernew et al.
Presently Medicare requires copayments for many of its services, but until now home health care has been the exception rather than the rule.
The investigators manipulated medication copayments for a subset of employees of Pitney Bowes, a self-insured company.
For a total of 2,830 employees, copayments for statins were eliminated and the co-payment for clopidogrel was significantly reduced.
This policy can make an impressive difference in your bottom line, but you need to keep in mind that even if the collection of office-encounter copayments has been successful, collecting the larger amounts required for surgical procedures can be challenging; in fact, collecting these larger prepayments from patients can be downright uncomfortable for your staff.
In the study, copayments for a mammogram ranged from $12.
Designed for patients on nonformulary medications, the program waives the copayment if the member moves to a generic alternative.
It will suffice to say, however, the erroneous copayments for the most part are due to software glitches in VHA's automated computer billing systems.
As insurance costs go up, employers cut back--sometimes reducing coverage, reducing financial support, or increasing deductibles and copayments.
Federal law allows states to require beneficiary contributions, such as premiums and cost sharing (coinsurance, copayments, and deductibles), for at least some Medicaid and SCHIP beneficiaries.
The AMA will seek federal legislation to require secondary insurers to pay Medicare deductibles and copayments, regardless of how much Medicare pays for the service.
Saying the cost was "too high compared to private health care," VA Secretary Anthony Principi lowered VA's outpatient copayments in December.