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.
Farlex Financial Dictionary. © 2012 Farlex, Inc. All Rights Reserved

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.

Dictionary of Financial Terms. Copyright © 2008 Lightbulb Press, Inc. All Rights Reserved.
References in periodicals archive ?
* Limit on Medicare drug copays: Medicare's "Part D" prescription drug benefit currently has no limit on out-of-pocket costs paid by patients, which means beneficiaries taking very expensive medications may wind up with copays rivaling a mortgage payment.
Ireland-based Jazz Pharmaceuticals, Denmark-based Lundbeck and United States-based Alexion Pharmaceuticals have agreed to pay a total of USD122.6m to resolve allegations of paying kickbacks through copay assistance foundations, it was reported on Friday.
Holy Name Medical Center, Hackensack Meridian Health, RWJBarnabas Health and Atlantic Health have announced that they will also waive copays for furloughed federal employees.
Enrolled beneficiaries can take advantage of a $0 deductible on all covered drugs in most states and $0 copays for 90-day supplies of Tier 1 drugs nationwide when filled through the CVS Caremark mail-service pharmacy.
If one were to bypass them by writing "no copay" on a bill, an insurance company likely would either bill the patient for the uncollected amount or send the doctor a letter saying he or she is in violation of a contract.
Consumer advocates worried that the NAIC should not detail a "fallback position" to copays or it would undercut the message that no cost sharing should be the stance.
In addition to a medicare supplement comparison tool Vertex Insurance has also introduced a program with plans that help to offset the copays that medicare advantage plans typically do not cover.
A review of 132 publications found that for each 10% increase in patient cost sharing (eg, copays, coinsurance, coverage caps), prescription drug spending fell by 2% to 6%, depending on the drug class and patient's condition.
Collecting copays and deductibles is essential in today's tight healthcare environment.
The study bolsters the idea of "value-based insurance" in which insurers lower copays and other costs to patients as a way to promote the use of tests and drugs that are proven to be cost effective in the long run.
Thirty years later, Gruber compares the HIE results--including the fact that higher copays generally lead to lower levels of utilization, although apparently without compromising patient health status--against newer, similar studies.