Q: What's the difference between a copay and coinsurance for therapy?
A: A copay is a fixed amount you pay for a covered service. Coinsurance is a percentage of the plan's allowed amount. Either may apply before or after a deductible; your plan document controls the answer.
Worked example: plan A charges a $30 copay → 20 sessions = $600/year, predictable. Plan B charges 20% coinsurance on a $120 negotiated rate after a $1,500 deductible → roughly $1,500 + (20% × $120 × remaining sessions) ≈ $1,700+ in year one.
Read the answer in this order
| Plan answer | What to write down |
|---|---|
| Copay | Flat dollars per session |
| Coinsurance | Percentage and the negotiated amount it applies to |
| Deductible applies | Amount remaining before the plan starts paying |
| Deductible waived | Your copay or coinsurance may apply immediately |
Ask the representative to quote the benefit for in-network outpatient mental health, CPT 90834. Then ask for the call reference number. Your benefits document is useful, but the code-specific answer is the number you can budget.
Do this: ask your plan: "For CPT code 90834, outpatient mental health, in-network — do I pay a copay or coinsurance, and is the deductible waived?" Asking by code number gets a real answer.
Sources: CMS health-insurance terms and HealthCare.gov coinsurance glossary.