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Related to out-of-pocket costs: Opportunity costs, Sunk costs


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 ?
With these measures, people who can least afford high out-of-pocket costs can continue to access services through a strengthened Extended Medicare Safety Net, Dr Seidel said.
There are two ways for employees to pay out-of-pocket costs with before tax dollars: Flexible Spending Accounts and HSAs.
Customers anticipating major medical events or high out-of-pocket costs can choose an hourly advisory option, which assists in ensuring the proper utilization of benefits, or a contingency plan that requires a fee only if outstanding bills have been resolved.
That's even with additional financial subsidies that the law provides people with modest incomes and high out-of-pocket costs.
People with limited income also may qualify for help to reduce the out-of-pocket costs of a plan
First, we estimate how the probability of initiating therapy responds to out-of-pocket costs per claim and income among individuals utilizing any of the five medications considered.
The auditors found that the health care facilities routinely waived out-of-pocket costs and inappropriately billed United Health Care, the state's insurance administrator.
Deducting the resale value of the old combine after five years and the tax savings from check-ups, repairs, overhaul, and depreciation leaves net out-of-pocket costs of $30,409.
There's no question that increasing out-of-pocket costs for consumers makes consumers seek out cost information.
For the 2006 year, the company expects service revenue, excluding reimbursed out-of-pocket costs associated with client projects and programs, to be in the range of $325 to $330 million.
Dual eligibles, and those who are eligible for a Medicare Savings Program or get Supplement Security Income (SSI) benefits, automatically qualify for "extra help" to reduce their out-of-pocket costs.
Being able to recover all reasonable out-of-pocket costs and potentially lost wages should encourage taxpayers to litigate cases where the IRS appears to have no reasonable basis for the items in a deficiency notice.