Wiki Is copay counted towards OOP? If so, how do insurance companies track the accumulation?

[sjooemmy08]

I know some insurance companies do put it on the EOB, but some payers don't.
BCBS sure does count it towards OOP based on the claim providers submit.

But how about other payers? Do they count copays towards OOP?

 

[thomas7331]

It used to be that different payers counted out-of-pockets costs differently - some included things like copays and deductibles and others didn't. But when the Affordable Care Act was passed in 2010, it mandated that any patient share paid toward a covered medical service, i.e. any deductibles, coinsurance, copays, etc., all must be counted towards the total out-of-pocket. So almost all plans should be doing this the same way now - there may be a limited number of plans that are exempt from this rule but there probably aren't many of those.