What Is A Copay & What Does No Copay Mean?

Learn about client copays at your private practice. Find out what a copay is, what no copay means, and if copays have to be paid upfront.

If you’re just starting out with insurance in your nutrition private practice, it’s important to understand how you will identify, and collect, client copay amounts. Even more, having a way to securely store your client’s financial information is critical, so that you may collect copays for subsequent visits. As your client load increases, it can become quickly difficult to keep track of client copays, and ensure that the proper amounts were billed and collected from clients.

In this article, we’re answering FAQs pertaining to managing wellness client copays for dietitians. Learn how to know if your client has a copay, when to collect it, and what office policies to put in place that address client copays.

Guide to Client Copays for Private Practices

1. What is a Copay?

I’m sure you’ve heard it before and are familiar with them, at least from the client’s side of things. Copays (or Copayments) are a fixed amount a client pays for covered medical services (which may include nutrition counseling services). The remaining balance is covered by your client’s insurance company.

Copay amounts can differ, depending on the plan that your client’s company negotiated. For example, two clients with United Health Care plans can have different copays.

In general, when you look at your client’s insurance card, copay amounts are typically listed. The may be next to the “office” or “visit” copay. Even more commonly, nutrition services may be considered a service, so if your client has a “specialist” copay, it will likely be this amount.

For example, your client may have a $20 copay every time they have a session with you. This means they pay you this allotted amount with whichever way you decide to bill your client (we will get to how your clients can do this later on).

If there is a $0 next to the “copay” amount, then this likely indicates your client will not have a copay. However, if there are no copay details indicated at all on the card, this does not mean that there is no copay. Some insurance plans do not list copay amounts on cards.

You can learn how the cost of your client’s copay through the insurance company when you verify their benefits. This can be done by calling the insurance provider directly prior to your client’s initial consultation. Most providers want to verify that the client is covered for nutrition counseling services, how many sessions (or hours) of counseling they are eligible for, and whether they have a copay and/or deductible.

A deductible is a fixed amount a patient must pay each year before their health insurance benefits begin to cover the costs.

2. Do clients have to pay copays upfront?

No, the copay depends on their insurance plan and can change from year to year. Make sure to receive a copy of their insurance card each year to stay up to date on their copay amount.

With many insurance plans, preventive services are covered at 100% — meaning, the patient doesn’t owe anything for the appointment. If nutrition counseling services are being billed as preventative services, then it is likely your client will not owe a copay for the sessions.

3. Can clients pay for their copays upfront?

Yes, if they have a copay listed on their card, or their insurance provider confirmed their copay amount when you checked insurance benefits, then you can have clients pay for their copay at the time of session. Some providers prefer to collect the copay before the session while handling client paperwork and/or collecting a credit card on file. Others prefer to let the clients know they will have a copay, but collect it at the end of the session.

Alternatively, many insurance-based practices do not charge for copays at the time of visit. Instead, they submit the entire claim to the insurance company, and when they receive reimbursement details it will indicate that a client owes a copay amount to the provider. You can then collect the copay from the client by sending them an invoice, requesting payment or charging their credit card on file.

When deciding when to collect your client’s copay amount, choose the option that feels the most comfortable for you. It’s up to you to set the policies in your wellness practice that work best for your business.

4. Do clients owe a copay for every session?

Typically, if a client has a copay then yes, they will owe their copay until they meet their out-of-pocket maximum. This means that the responsibility the client owes and must pay independently has been satisfied, and the insurance carrier will now take on the remaining amount.

If you submit a CMS 1500 claim to the insurance company, you’ll receive back financial details in the EOB. The EOB will indicate the amount that was covered by the insurance provider, and what remaining amount the client owes. If they owe nothing, as the service was paid at 100% — then your client does not owe a copay. If you already collected the copay in advance, then you can reimburse your client the amount they paid.

5. How can clients pay for their copays?

There are a number of ways in which your clients can pay. Every practice has its own terms and established rules, so the type of services you offer determines how your clients will pay their copays. Below are the most common ways that practitioners obtain their clients copays:

  • Charge their credit card,
  • on file for the copay amount
  • Send them an invoice for the copay amount
  • Accept cash for their copay (for Healthie members: you can indicate this as an outside payment)

6. Can I charge my client a copay to their credit card on file?

As best practices, you’ll want to address copays (and insurance billing) in your financial agreement form. This will allow clients to fully understand their financial responsibility and how they will be charged for copays. Communicating these policies upfront allows for better expectations and less miscommunication.

Leverage Healthie, an all-in-one practice management platform where you can conveniently navigate your clients copays based on their insurance providers in a feasible fashion. This will save both you and your clients time during their visits with you. Saving time will allow you to focus your attention on growing your private practice and reaching even more prospective clients.

Using a Practice Management Platform for Client Copay Processing  

In one, consolidated platform, Healthie offers all the HIPAA-compliant tools to manage:

  • Client scheduling with automatic appointment reminders
  • Automated new client paperwork that clients can electronically complete and sign
  • EHR with included charting templates, or customize your own
  • CMS 1500 claims creation
  • Client billing for self-pay services or patient responsibility (copays, deductibles, denied coverage)

For Healthie providers, see how you can indicate a wellness client’s copay in this help article.

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