A copay is the set fee you pay at every medical session, including therapy.
When you see a therapist who is in-network with your insurance plan, you pay them a copay at each therapy session. Then, your therapist sends a claim to the insurance company to receive the remainder of the fee they're owed.
If your copay is $25 per session, that’s the rate you are responsible for paying every time you have an appointment.
Your therapist receives additional compensation, which is a specific rate for in-network providers set by the insurance company.
How does my deductible affect my copay?
Whether or not your deductible affects your copay depends on the type of plan you have with your insurance provider. When you have paid enough in medical costs that the sum of costs equals your deductible, it is often referred to as "meeting your deductible."
Deductible IS NOT affected by copay: For some plans, you will always pay a copay for your therapy appointment, even if you haven’t hit your deductible yet.
- What does this look like? Every time you show up for your therapy appointment, you will pay a copay. Let’s say with Aetna, your copay is $50, so regardless of the therapist’s session fee you’ll be charged only $50 at every appointment. If your sessions are virtual or online, you may have a payment option, such as a credit card, on file that will be charged that copay amount before each session.
Deductible IS affected by copay: Some plans require you to hit your deductible before the copay applies.
- What does this look like? If you must hit your deductible before your copayment applies, then you will pay your therapy sessions in full until your deductible is met. Let’s say that Aetna’s copay for therapy sessions is $50, and the deductible is $2,000. You would have to spend $2,000 meeting your deductible before you can start paying only the $50 copay per session — and you can meet your deductible by paying those full therapist session fees.
Do note that usually any medical expense, such as a doctor's visit or medication prescription, contributes to reaching your deductible. This means that these medical expenses can contribute to your deductible — not just the therapist’s full session fees. Continuing with the example above of Aetna’s $2,000 deductible; let’s say you paid $500 for an OB-GYN service, and another $700 for an urgent care visit. That totals up to $1,200 of your deductible, which means that after those services, you’d only have to pay another $800 of full therapist sessions fees and/or any other medical expense before you start to only pay the therapist copay of $50.
If you have a deductible with your health insurance plan, your copay may apply after your deductible has been met — talk to your insurance provider to find out what fees you can expect to pay before your sessions.
Do I have a copay for out-of-network therapists?
Although there are no copays when you use a doctor or facility that is out-of-network, you are responsible for paying a percentage of the total bill – the coinsurance.
This is usually much higher than the in-network copay amount.
So copays only apply to in-network therapists?
Yes. If a therapist is “in-network” with an insurance company, they have agreed to accept the rate an insurance company is willing to pay per session. You would pay your therapist a “copay,” after each session, and your therapist would also receive that separate additional compensation from the insurance company.
Is a copay always the cheapest option?
No. If you have good out-of-network benefits, your insurance company may reimburse you as much as 80% of each session fee, depending on your plan and the therapist’s rate.
This means that in some situations, using your out-of-network benefits can actually be more affordable or comparable to your standard copay to see an in-network therapist.
How do I figure out what my copay is?
The amount of your copay depends on the details of your specific plan. You can find this amount on your Explanation of Benefits (EOB), listed as “allowed amount.”
If you’re unsure about the details of your specific coverage, contact your insurance company. You can search on their member services page, or call the number on the back of your insurance card.
Find in-network and out-of-network therapists on Zencare.co!
If you need help navigating health insurances or using out-of-network benefits, visit our guide to using health insurance for therapy.