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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.
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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.

Dictionary of Financial Terms. Copyright © 2008 Lightbulb Press, Inc. All Rights Reserved.
References in periodicals archive ?
Veterans were exempt from copayments if they were low income or had disability from their military service to merit a need-based exemption.
In the standard model, the more responsive health care use is to price, the greater the efficiency cost of low copayments, as people overuse care to a greater extent.
Johnson added that the prescription drug copayments for both the Medex and Tufts Medicare Complement health plans are being standardized to align with the other two Medicare plans offered by the city: Fallon Community Health Plan Senior HMO and the Tufts Medicare Preferred HMO Prime plans.
Because of the difference in the incidence of heart attacks and other problems, Aetna's cost of providing care for the average free-drug patient was $64,726; the average for copayment patients was $69,997.
The essential benefits package of these plans includes Bright Futures services with no copayment. Other important services such as pediatric vision, oral health, and therapies are included, with cost sharing ranging from 60% to 90% of the actuarial value of covered benefits.
Presently Medicare requires copayments for many of its services, but until now home health care has been the exception rather than the rule.
The downside is that these drugs will have no generic (cheaper) form for many years and will come onto the market with Tier 4 copayments.
The amount of the copayment was strongly associated with abandonment, such that prescriptions with copayments lower than $10 were abandoned 1.4% of the time, compared with 4.5% of the time for copayments greater than $50.
They said members who fill their prescriptions at preferred pharmacies, including those in Walmart, Neighborhood Market, and Sam's Club locations, can have copayments of as little as $2.
Review your health care policy to see whether your deductibles, copayments, and co-insurance count towards this limit."
If you decide to start collecting surgical copayments and deductibles in your practice before surgery takes place, it is important to institute this policy in an appropriate manner, with compassion and sufficient patient education.