What is it called when I pay a set fee when I see a doctor or specialist?
Jackson Reed
Updated on February 10, 2026
For most insurance plans, every time you see a doctor after meeting your deductible you pay a set amount called a copay. A copay works as a flat-fee your general practitioner or specialist charges you for using their services. Copays are a form of cost sharing with your health insurance company.
What is it called when you pay a fixed amount each time you visit the provider?
A fixed amount ($20, for example) you pay for a covered health care service after you’ve paid your deductible. Your copayment for a doctor visit is $20. If you’ve paid your deductible: You pay $20, usually at the time of the visit.
What do you call the fee that you pay when you use a medical provider?
Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care.
What is a predetermined flat fee you pay for health care services?
Co-payment is a predetermined (flat) fee that an individual pays for health care services, in addition to what the insurance covers. For example, some HMOs require a $10 “co-payment” for each office visit, regardless of the type or level of services provided during the visit.
How does a capitation plan work?
Capitation is a fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services. If the health plan does well financially, the money is paid to the physician; if the health plan does poorly, the money is kept to pay the deficit expenses.
What are the pros and cons of fee for service?
Fee-For-service:
| Pros | Cons |
|---|---|
| Encourages the delivery of care and maximizing patient visits | Offers little or no incentive to deliver efficient care or prevent unnecessary care |
How do insurance companies determine allowed amounts?
Your insurance will look up the amount they will allow for each CPT code on the bill based on the healthcare provider you saw and other variables. This price is then used to calculate either the amount applied to your deductible or how much money you will be reimbursed based on your co-insurance.
What does 80% coinsurance mean?
Under the terms of an 80/20 coinsurance plan, the insured is responsible for 20% of medical costs, while the insurer pays the remaining 80%. 1 However, these terms only apply after the insured has reached the terms’ out-of-pocket deductible amount.
Why do doctors charge more if you have insurance?
One of the most commonly used practices is overcharging with the intent to negotiate the total costs. Hospitals and doctors often charge exponentially high rates for common practices with the expectation of negotiating with insurance companies.
What kind of fee schedule does CMS use?
CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies. See Related Links below for information about each specific fee schedule.
What do you need to know about Medicare fee schedules?
Fee Schedules – General Information. A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers. This comprehensive listing of fee maximums is used to reimburse a physician and/or other providers on a fee-for-service basis.
How to set a practice’s fee schedule?
I am focusing only on setting the overall fee schedule for the practice once you know your allowables. The main goals or principles to consider when setting a fee schedule are:
How does a fee for service payee work?
What Is A Fee-For-Service Payee? Is authorized in writing by SSA to collect a fee as payment for providing representative payee services. The fee is collected from the beneficiary’s monthly Social Security and/or Supplemental Security Income (SSI) benefits.
