Paul's Heart

Life As A Dad, And A Survivor

Copays

Up until the Affordable Care Act became law (and it is the law), we were lucky if we heard the word “copay”, as in, your portion of the bill to pay for seeing your doctor. And for a good many of us, our copay, what we pay before the insurance picks up the rest of the tab, or at least the majority of the bill, the copay is fairly reasonable considering the service rendered, usually ranging between $10 and $35 for a simple primary care visit, perhaps a little more for a specialist.

For the average working citizen, this copay may be a bit trivial in the amount. $10 can buy a movie ticket, a super-sized value meal at a fast food restaurant, or two lottery scratch tickets. But for the patient on a fixed income, the copay amount is not trivial at all. Sometimes it is the difference of being able to be seen by a doctor, or delaying the visit.

For either patient though, and for the sake of this post, I am not arguing against the copay itself, but rather when it is implemented. Sure, I will not argue that a copay should be paid for an initial office visit with the doctor (most copays are often only paid when you see an actual doctor, not a nurse or practitioner). But what about the repeat or follow up visits, required by the doctor, for the same ailment?

Example one. You have a severe sinus infection which requires antibiotics. You go into to see your doctor, get charged a co-pay. The doctor prescribes you some medicine and wants to see you again in a couple of weeks to see how you are feeling. Of course, when the two weeks comes around, you are feeling fine. Should you just call the doctor and say that you are feeling fine? Should you go ahead and follow up with the doctor, which of course means you will most likely have to pay another co-pay even though it was the doctor that requested your presence, not the other way around.

Example two. A patient is diagnosed with cancer after paying the copay. A couple more appointments with the doctor, required by the doctor, also including a couple more copays, and treatment begins. There are some follow-ups to be seen by the doctor during the treatment regimen. Even though the patient is followed up by bloodwork and possibly other tests, the doctor wants to see the patient, but that also means collecting another copay.

There are plenty of other examples where a patient is required to return back to a doctor, by the doctor, and have to pay another copay. I do not know, but if you pay the copay once, the entire service should be covered regardless of the number of times that you are seen for that one illness. For a working person, this may not seem like that big a deal, but for someone on a fixed income, such as someone who is retired or on disability, a thirty-five dollar copay to see the oncologist for one particular patient cost the patient close to two hundred dollars before the first chemotherapy drug went into his veins just in consultation visits.

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