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> If you have a percentage copay, say 10%, they will tell you to pay $25k because it's 10%, but they might only pay $75k. In this example you clearly paid 25% b

> If you have a percentage copay, say 10%, they will tell you to pay $25k because it's 10%, but they might only pay $75k. In this example you clearly paid 25% but they tell you it's only 10%. I think this is coinsurance, not copay. Copay is the $50 (or whatever) flat fee you pay every time you see a specialist. Coinsurance is a percentage of costs that you share with the insurance company, up to some maximum out of pocket amount. I believe that this percentage is always on the negotiated rate, not on the original charge.

100011_100001 5y ago
A lot of insurance companies will have a 10-20% coinsurance for hospital visits, not a traditional co-pay like you went to a specialist. That 10-20% goes against the deductible, so depending on the bill you might not even pay the full 10% because it hits your deductible max. Edit: I was informed that it's not 10% co-pay but coinsurance. So I updated my post to reflect that.
- astura 5y ago
  That kind of cost sharing is called coinsurance, not copay. Most policies have deductibles, coinsurance, and copays as types of cost sharing. Coinsurance you pay is also against the amount that insurance pays (negotiated rate)
  - 100011_100001 5y ago
    Thanks for the clarification on coinsurance.
- sumtechguy 5y ago
  That is highly dependent on what your plan is. Some plans are flat co pay. Some are percentage. Some are mixed. Some max out at particular amounts, some dont depending on the care you are doing.
jzwinck 5y ago
Thanks I edited my comment to say it's called coinsurance. But the point is the same, and in my experience it is not always based on the final negotiated amount actually paid to the healthcare provider.
- IG_Semmelweiss 5y ago
  its probably because EOBs are convoluted but that's most certainly not what you saw, because what you claim to have seen would be very serious fraud. Medical billing is not to be messed with.
- sjg007 5y ago
  It should be 10% of the insurance negotiated amount.

100011_100001 5y ago

A lot of insurance companies will have a 10-20% coinsurance for hospital visits, not a traditional co-pay like you went to a specialist. That 10-20% goes against the deductible, so depending on the bill you might not even pay the full 10% because it hits your deductible max. Edit: I was informed that it's not 10% co-pay but coinsurance. So I updated my post to reflect that.

astura 5y ago
That kind of cost sharing is called coinsurance, not copay. Most policies have deductibles, coinsurance, and copays as types of cost sharing. Coinsurance you pay is also against the amount that insurance pays (negotiated rate)
- 100011_100001 5y ago
  Thanks for the clarification on coinsurance.
sumtechguy 5y ago
That is highly dependent on what your plan is. Some plans are flat co pay. Some are percentage. Some are mixed. Some max out at particular amounts, some dont depending on the care you are doing.

jzwinck 5y ago

Thanks I edited my comment to say it's called coinsurance. But the point is the same, and in my experience it is not always based on the final negotiated amount actually paid to the healthcare provider.

IG_Semmelweiss 5y ago
its probably because EOBs are convoluted but that's most certainly not what you saw, because what you claim to have seen would be very serious fraud. Medical billing is not to be messed with.
sjg007 5y ago
It should be 10% of the insurance negotiated amount.