Not All Doctor’s Office Visit Copays Are Created Equal

The benefits covered under a doctor’s office visit copay vary widely among health plans.

Compare Allied National’s Funding Advantage office visit benefit to the competition and you’ll quickly discover that our benefit plans are unique.
 
Allied’s health plan copays cover almost anything that happens during the visit up to a certain dollar amount. Many health plans only cover the actual doctor exam or visit under the copay.

So, what's a copay?

A copay is a predetermined rate you pay for health care services at the time of care. For example, an insured member might have a $30 copay every time he or she sees their primary care physician, a $10 copay for each monthly prescription and a $250 copay for an emergency room visit.
 
The copay (short for copayment) for different services within the same plan, like drugs, lab tests and visits to specialists can vary within the same plan.
 
So, what does your copay actually cover? Well, it depends on the health insurance plan.
 
For example, the copays for Allied’s Funding Advantage plans that feature the office visit benefit, cover a variety of services performed at the doctor’s office, such as:

• Exams
• Consultations
• Diagnostic testing
• X-rays
• Allergy antigen injections
• Chiropractic treatment
• Surgical services
• COVID-19 testing

Preventive care generally is provided at no cost to the patient thanks to the Affordable Care Act, so copays would generally not apply for these office visits.
 
It’s smart to keep in mind that your company’s health plan may have provider network rules. If you go out of network, your copay may be more, or you may be required to pay the full amount for the services.
 
The typical health plan often only covers the actual office visit consultation under the copay and all other services are subject to deductible and coinsurance.
 
Copay amounts may change annually depending on your company’s health insurance premiums, so it’s worth checking in with your HR department to find out if the amounts have gone up, down or stayed the same when a new year begins. These are the types of benefits that go a long way toward providing a quality employer-sponsored health benefit plan.

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Allied National

Founded in 1970, Allied National is one of the nation's oldest and most experienced third-party administrators. We're the small group benefit experts working to provide unique and affordable group health benefits to small business employers.