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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 ?
It is critical to cash flow to collect copays at the time of service and, in fact, it is a contractual obligation for the provider.
While employers may take upfront financial hits when waiving copays, opportunities abound for substantial long-term savings.
Health plan managers and policy makers use copays as a means of controlling prescription drug costs.
Sevon agreed that three-tiered copays reduce physician hassle factors, but they also make patients more aware of the formulary, she said.
Collecting copays after a patient has left your office is not only difficult, but expensive.
The probability of having seen a primary care provider in the past year was nearly identical--ranging from 77% to 80%--among those with no copays, with copays of $5 or less, $5-$ 10, or more than $10.
The biggest change, of course, is that premiums have increased substantially To help offset these costs, members with traditional plans have been forced to absorb more out-of-pocket risk in the form of higher copays, bigger deductibles, and increased coinsurance amounts.