What is a copay?

Copays are flat fees that insurance companies require that members pay for their care. Copays, once simple and straight forward, are now becoming more complex. Not only are there different copays for different places of service and service providers (office visits vs emergency room visits; specialist vs primary care), but recently more insurance companies have instituted gradations of copays tied to quality assessments of physicians in their networks. Typically these quality designations are based not only on the quality of their clinical care, but also on the cost of that care to the insurance company.

What is a copayment and how is it determined?

In order to incentivize their members to utilize the quality providers in their network, insurers are either removing the patient’s responsibility for the copay entirely or reducing the cost of that copay if members use one of the quality physicians in the network.

What is my copay?

Check your plan to see if copay savings are available to you via quality physician networks. Your insurance ID card might detail those copays. If not, contact customer service for your plan to see if you can access these savings.



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