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.