What is a Copayment?
A copayment - or copay - is the amount you - as an insured person - pay for an expense when you visit a doctor, laboratory, ambulatory care center, hospital, or pharmacy. It's a set amount of money for a certain kind of provider. For example, if you see a primary care doctor, it may cost you a $25 copay; if you see a specialist, it may cost you a $50 copay. Each time you see that doctor for your health care, you'll pay the same copay at the time of service.
The copayment amount varies depending on your insurance plan. When the copayment is displayed as a pair of numbers - for example, $15/$30 - the first amount is usually for an office visit with your primary provider (this can be a family practitioner, internist, general practitioner, or pediatrician) and the second amount is for a specialist (a heart doctor, for example).
What is Co-Insurance?
Coinsurance is the amount you pay after your visit to the doctor, laboratory, or hospital - and it's expressed in percentages. Your health insurance pays the remaining percentage. This is often expressed as 80/20 - where you owe the 20% and your plan pays the 80%.
What is a Deductible?
Throughout your plan year, the coinsurance amount you pay adds up to meet a certain predetermined amount - called your deductible - which can range from $1,000 to $5,000 a year. Once you meet your maximum out-of-pocket, you won't have to pay coinsurance for the rest of the plan year. You will, however, have to continue to pay copays. Generally, once you meet your deductible, your plan benefits kick in. Though some benefits may be available before a deductible, it depends on the plan.
Beginning March 1st, 2013 all co-pays will be required at the time of service. If you do not know the amount of your co-pay, please contact our office before your visit.
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