What does Copay mean?

A copay, or copayment, is a fixed amount a health plan may require a member to pay for a covered visit, service, prescription, or other item. The amount can vary by benefit category, network tier, place of service, or drug tier. Although copays are often collected at the time of care, the final claim can be processed differently if the service was not covered, the provider was out of network, or another plan rule applied.

Do not assume every amount collected at check-in is the final copay. Compare the receipt with the EOB and provider bill after the claim is processed. Some plans apply a service to the deductible instead of, or before, a copay; others cover certain preventive services without cost sharing when requirements are met. The plan's Summary of Benefits and Coverage and full plan document are the best places to check. If the bill lists both a copay and another patient amount, ask the plan and provider to explain how the payment was credited.