What is a Co-pay?
When products or services are NOT covered 100% by an insurance carrier, part of the expense is paid for by the patient. How Much is the Co-Pay For This Product/Service? Generally the co-pay amount for a primary payor (set by the insurance carrier) is in the form of a percentage or fixed dollar amount of the total allowable charge for that particular item or service. In the case where the patient has a Medicare coinsurance policy (such as AARP or BC/BS 65 Special) the co-payment amount is after Medicare pays 80% of the total allowable charge for that particular item or service. If the coinsurance carrier pays only part of the 20% after Medicare, then the remaining balance is the patient’s responsibility. To calculate a co-payment if you only have a primary insurance you must take the provider’s billable amount (or the insurance carriers maximum allowable amount, whichever is less) and multiply it times the co-pay percentage you are responsible for. Example: $195.00 Providers Billable Am
