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What is a co-pay? 


 
A co-pay is a portion of patient financial responsibility set by the patient’s insurance company. Different benefit types may have different co-pay amounts. For example, an insurance plan may impose a $20 co-pay for a primary care physician visit and then a $50 co-pay for a specialist, like an orthopedic surgeon. Some plans and/or benefits may be subject to a $0 co-pay. The co-pay amount is often printed on the insurance card and is typically always collected at the time of service. 

Some insurance plans place limits on how much money a patient can be responsible for during a calendar year. The co-pay may or may not go towards that patient financial responsibility limit, or out of pocket maximum. 

The only way to be certain that a patient is paying the correct co-pay for a service is to contact the insurance company and provide the exact billing code for the service.



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