Yes, You Can Still Get a Medical Bill After Paying Your Copay – Here’s Why

You go to the doctor’s office pay your copay at the time of your appointment, and assume that covers the full cost of the visit. But a few weeks later you get a bill for additional charges. Sound familiar? This is a common occurrence that can be confusing and frustrating for patients. In this article I’ll explain why you can still receive a medical bill even after paying your copay upfront.

What is a Copay?

First let’s review what exactly a copay is. A copay is a fixed dollar amount you pay at the time of a doctor visit procedure, or prescription fill. It’s paid every time you access these services regardless of the total cost.

Copays typically range from $10-$50 depending on your insurance plan and the type of care Common copays include

• $20 for a primary care physician visit
• $40 for a specialist visit
• $10-$15 for a generic prescription
• $30 for an urgent care clinic visit

Copays apply before you’ve reached your deductible. They do not count toward your deductible.

Why Do I Owe More if I Already Paid the Copay?

When you pay the copay at your doctor or hospital visit, you are only paying a small portion of the total charges upfront. The copay does not represent the full cost or allowed amount for the services rendered.

After your appointment, your provider sends a claim to your health insurance plan listing all services performed and total charges. This is when the full contracted rate for the visit is calculated between your provider and insurance company.

If the total allowed amount is higher than your already paid copay, then your insurance will expect you to cover a portion of the remaining charges in the form of coinsurance or deductible payments. This is why you can receive a bill weeks later even after paying your copay that day.

Here is a simplified example:

• Total charges for doctor visit: $200
• Allowed amount by insurance: $150
• Your copay: $20
• Remaining allowed amount: $130
• Your coinsurance: 20%
• Your portion of coinsurance: 20% of $130 = $26

In this example, you would owe $26 in coinsurance in addition to the $20 copay you already paid upfront.

Common Additional Charges on Medical Bills

Aside from coinsurance, here are some other common charges that may appear on a medical bill after your visit:

• Deductible – If you have not met your annual deductible, you pay 100% of allowed charges until reaching your deductible amount.

• Lab tests – Blood work, pathology, or imaging services often have separate cost sharing that applies in addition to the office visit copay.

• Vaccines – Vaccines may be covered differently than a regular office visit and could have an additional charge.

• Out-of-network – Seeing a provider that is out-of-network for your plan can result in higher charges.

• Prior authorizations – Some services require approval from the insurance company first to be covered. Lack of approval can lead to patient responsibility.

How to Avoid Surprise Medical Bills

Getting unexpected bills after you’ve already paid your copay can certainly be annoying. Here are some tips to help avoid surprise medical bills:

• Check billing practices – Ask if the doctor sends bills directly or through a separate billing company. This gives you an idea of what to expect.

• Don’t ignore bills – Open all medical bills promptly to check for errors and understand potential patient responsibilities.

• Review EOBs – Explanation of benefits statements from your insurance outlines what was covered and what you owe.

• Understand your plan – Know details like deductible amounts, coinsurance rates, copays for different services, and out-of-network coverage to minimize surprises.

• Use in-network providers – Staying in-network helps reduce out-of-pocket costs for patients.

• Ask about costs – Request cost estimates from both the provider and your insurance plan in advance for predictable expenses.

How to Pay and Dispute Medical Bills

If you do receive a bill after paying your copay, here’s how to handle it:

• Pay promptly for accurate bills – Pay legitimate outstanding balances within 30 days to avoid late fees or collection actions.

• Set up a payment plan – Contact the billing office to arrange installment payments if you can’t pay the full balance due.

• Negotiate discounts – Ask if there are any prompt payment or self-pay discounts if you pay the entire bill immediately.

• Check for errors – Review bills for duplicate charges, incorrect dates/services, or other mistakes before paying.

• Appeal if necessary – You can appeal charges to your insurance company if you disagree with their coverage determination.

Getting a medical bill after your copay can be perplexing, but is very normal. Now you understand why this occurs and how to manage these additional expenses. With some diligence, you can reduce surprise bills and take control of healthcare costs.