Lessons · Pharmacy · the copay and the patient's share
The copay and what the plan pays
The copay is the patient's share, fixed by the plan, and what the plan pays is the price less that share.
Hone is a place to practise a career, one idea a day. This is one of its lessons, written out in full and free to read without an account.
What it is for
The number on the screen and the number the patient hands over are two different numbers, and the patient will ask about the difference. Being able to say what the plan paid, in dollars, ends the conversation in ten seconds.
How to think about it
Start from the price. If the plan gives a flat copay, subtract it. If it gives a percentage share, called coinsurance, work that percentage of the price first and then subtract. Either way the two parts add back to the price, and that is the check.
Worked example
Price $62.00, copay $15.00Both given by the plan's response.
Plan pays = $62.00 - $15.00 = $47.00The rest of the price.
A 20% coinsurance on $62.00 = $12.40A percentage share instead of a flat one.
Plan pays = $62.00 - $12.40 = $49.60The same subtraction, and $12.40 + $49.60 = $62.00.
Your turn
The price is $80.00 and the copay is $25.00. Write what the plan pays.
80.00 - 25.00 =
Solve one, graded on the server
The trap
Charging the copay on top of the full price. The copay is part of the price, not an extra; the two shares add to the price and no further.