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Out-of-Network Copayment

What is an out-of-network copayment?

Patients who visit healthcare providers typically have to pay a fixed amount called a copayment or copay. Out-of-network copayments are fixed amounts patients must pay when they visit providers outside their health plan's network.

Out-of-network copayments are typically more than in-network copayments. Out-of-network copayments also tend to be tied to specific healthcare services and thus vary by the services the patient needs. Health insurance plans with lower monthly premiums generally have higher copayments, including out-of-network copayments.  

Why are out-of-network copayments important to healthcare?

Out-of-network copayments are important in healthcare because they are a type of cost sharing, similar to deductibles and coinsurance, that patients must pay to receive care. These costs can affect the affordability of care. 

Typically, copayments to healthcare providers outside an insurer’s network (out-of-network providers) will be higher than those within the insurer’s network (in-network providers). This is because services have already been negotiated with in-network providers. As a result, patients may incur unexpectedly high copayment costs when they seek care from out-of-network providers. 

Some national copayment assistance programs exist to help offset the costs patients incur when seeking treatment from out-of-network providers for specific diseases.