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A copayment or copay (called a gap in Australian English) is a fixed amount for a covered service, paid by a patient to the provider of service before receiving the service. It may be defined in an insurance policy and paid by an insured person each time a medical service is accessed.
With indemnity dental plans, the insurance company generally pays the dentist a percentage of the cost of services. Restrictions may include the co-payment requirements, waiting period, stated deductible, annual limitations, graduated percentage scales based on the type of procedure, and the length of time that the policy has been owned.
In health care, cost sharing occurs when patients pay for a portion of health care costs not covered by health insurance. [ 1 ] [ 2 ] The "out-of-pocket" payment varies among healthcare plans and depends on whether or not the patient chooses to use a healthcare provider who is contracted with the healthcare plan's network.
Bronze plans usually have the lowest premiums but come with a high deductible—the amount consumers pay out of pocket before insurance kicks in. Bronze plans cover around 60% of medical bills ...
Prescription drug plans are a form of insurance offered through some health insurance plans. In the U.S., the patient usually pays a copayment and the prescription drug insurance part or all of the balance for drugs covered in the formulary of the plan. [5]: TS 2:21 Such plans are routinely part of national health insurance programs. For ...
For dentists, the American Dental Association defines a usual and customary fee as "the fee an individual dentist most frequently charges for a specific dental procedure independent of any contractual agreement. It is always appropriate to modify the fee based on the nature and severity of the condition being treated and by any medical or ...
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