Rate your provider

Why is there a health insurance copay on doctor's office visits?

View All Health Insurance Providers

What is the InsuranceMatchup Quality Rating?

By InsuranceMatchup Staff Writer

With most common health insurance coverage comes something called the copay, which the insured party is responsible for. Most commonly, this will be charged when visiting a doctor's office. But why is there a health insurance copay on doctor's office visits?

To answer this question, you first have to understand what a copay is. Basically, a copay is just a flat fee paid to the doctor's office each time the insurance is used. It usually runs between $10 and $40 and is charged up front prior to a doctor's office visit. The amount will also vary depending on the type of doctor you are visiting. Specialists sometimes require a higher amount of copay.

That's really all there is to the copay itself. Now as for why a copay is charged, that's a little more complicated. Not all insurance plans will require a copay for doctor's office visits. But, the plans with a copay will pay 100 percent of the charges incurred following the set amount of the copay.

So, let's say you go for a normal doctor's office visit. If you have a $20 copay, you'll be charged $20 before you leave the office. That's not the total cost of the visit. The whole process may cost upwards of $500, depending on what you had done. What this means is that you are only responsible for your $20, and the insurance takes care of the other $480, or 100 percent of the cost after the copay was deducted.

Copay insurance is very common, especially for office health insurance plans. In some cases, copays may not make a lot of sense, as they won't count towards any out-of-pocket maximum costs that the insured person has to pay each year. But it will help with the most common uses of health insurance, the doctor's visit.

Related Articles