Copayments are a routine way of sharing costs under most health insurance plans. A copayment, or copay, is the portion of medical costs that you cover out of pocket. If you have coverage under a group health or small business plan, responsibility of covering your copayments usually lies with you as a policyholder, and not your employer.
Let us delve more deeply into health insurance copayments, out-of-pocket costs, and reimbursement of copays if you suffer personal injuries in an accident.
What is a Copayment?
A copayment is an amount fixed in an insurance plan to share the cost of services covered under the plan, between the insurance company and the insured customer. This cost-sharing copayment system lays down the proportion that the customer owes for health services, doctor visits, prescriptions, and other medical costs.
It is vital to know the cost-sharing breakdown of an insurance plan. You must keep in mind that you may need to pay these out-of-pocket costs apart from the plan premiums and costs for any other non-covered services.
Certain preventive services such as annual medical checkups, childhood vaccines, and certain screenings are usually covered, without you having to pay out-of-pocket costs. The payment for these services is not subject to copayments or deductibles. Typically, there are three types of insurance plan cost-sharing:
- Annual Deductible
You will need to pay out of pocket even for covered services till you hit the insurance plan’s annual deductible figure. Your insurance takes over after that and starts paying while sharing the costs, or copay for certain services.
Typical Copayment Medical Services
Although your insurance plan and provider determine the rules for cost-sharing, you may generally owe copayments for:
- Your office visits with a physician involving non-preventive care
- Your office visits with a health care specialist
- Your prescriptions
- Your physical therapy
- Your occupational therapy
- Your speech therapy
- Your physiotherapy or office visits for mental health services like drug counseling
- ER or ambulance services
Under the Affordable Care Act, cost-sharing does not generally apply to preventive care, so office visits are exempt from copays. However, you may have to pay a higher proportion or even the full cost of services, if you flout your provider network guidelines by using a non-preferred physician or going out of network.
Do I Need to Make My Copayments if I Am Injured in an Accident?
The answer is: Yes. Because Virginia is an at-fault state, the third-party insurer representing the negligent driver will not cover the cost of your medical bills, until the settlement of your court case. The best way you can pay your medical bills after an accident is by using your health insurance cover, in which case there might be copayments that you must make.
If you are a victim of an accident, you must inform your health care providers of your health insurance plan. In case of injuries caused by a third party, some medical providers may not accept your health insurance. The reason behind this is purely monetary, as these providers stand to collect more out of case settlement proceeds, than from the health insurance company.
What Happens if You Do Not Make Your Copayments to Cover Your Medical Bills After an Accident?
In the event of you not paying, your copays may go for collections. You being forced to pay your bills, in addition to the suffering you are going through from injuries due to someone else’s negligence, may seem very unfair. Unfortunately, that is how it works in our system. In an at-fault state like Virginia, you must make copayments for your medical bills after an accident.
How Do I Pay the Out-of-Pocket Share for My Medical Bills After an Accident?
Mostly, auto insurance policies have Med Pay coverage, normally in increments of $2,500. You can use it to pay for your medical bills, unmindful of fault. However, any use out of your Med Pay coverage will need to be paid back to the auto insurance company out of your settlement proceeds.
Will I Get Reimbursed for My Copayments?
Under your health insurance plan, you need to make a copayment every time you use a medical service for your treatment. It is a small portion of the bigger medical bill for the treatment of your injuries.
If you make the copayments for the treatment of your injuries out of your med pay policy, you might need the receipts for getting reimbursed by your auto insurance company. However, when settling your personal injury case, your attorney will try to recover compensation for the entire medical treatment bill and not just the copayments that you made.
Contact a Virginia Personal Injury Attorney Today
Understanding the significance of copayment in an insurance plan, can help you make an informed decision. Weigh your options and consider your insurance cover accordingly.
If you are a victim of an accident caused by someone else’s negligence, talk to an experienced Virginia personal injury attorney today. The compassionate and qualified team of lawyers at Shapiro, Appleton & Washburn, understands the hardship and frustration you are going through in trying to pay for medical bills while dealing with your lost earnings and suffering, at the same time.
Leave it to us to work diligently to protect your legal and financial interests, and secure the maximum possible compensation for your injuries and damages. Call our office at 800-752-0042 today or contact us online for a free and confidential case review.