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How is Copay Determined

how is copay determined

In the ever-murky world of health insurance, several questions seem to go unanswered. For example, how is copay determined? We all have to pay for it, even if our deductible is satisfied and the insurance company starts pay the bills. One day it might only a dollar while a follow-up visit might be several hundred. There seems to be no rhyme or reason for how these costs are calculated, and when living on a tight budget, knowing how they are determined can mean saving money or missing your next rent payment. In this article we will review how copay fees are calculated and ways you can reduce your costs in order to keep your cash in your bank account.

How is Copay Determined?

So, how is copay determined? Your copay is calculated based on the original contract signed with the insurance company. Here you will find a schedule of copay terms that lets you know how much it will be each time you visit a doctor. It will be determined by how you go, where you go and even when you go to the doctor. If you know how to read your schedule, you can reduce the cost you pay on a copay when you do need to see a doctor.

What is a Copay?

So, what is a copay? Your copay is the administrative fee you pay directly to the clinic or hospital to cover the paperwork involved in your admittance. Even if your deductible is met for the year, you still have to pay your copay.

Copay Example

A solid copay example is when you show up for your annual physical. Before you see a doctor, you go through the admissions desk and confirm your insurance coverage. The nurse behind the desk will request the copay fee from you, anywhere between a dollar and several hundred dollars. This amount is based on your copay schedule attached to your insurance policy.

Copay vs Deductible

When seeking a balance between copay vs deductible, it all starts with your knowledge of how your policy is set up. How is copay determined? It is set at the time of your policy with your copay schedule. Here you will find the details of the costs required of you when visiting a doctor. Generally, the lower your deductible and premiums, the higher your copay will be. If your deductible and premiums are high, this will translate to a lowered copay. Base your balance on your budget and how much you can dedicate to your insurance costs. This balance is simple to predict, so know what you are signing up for before you chose a health insurance policy.

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