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What is a Provider Fee?

A Provider Fee is an amount paid by the member to a healthcare provider at each visit.

The provider fees are:

  • $0 for Telemedicine.
  • $50 for each primary care visit.
  • $75 for each specialist or urgent care visit.
  • $150 for emergency room or in-hospital visits.

These fees are not applied to the member's Primary Responsibility Amount (PRA) and are paid even if the member has met his/her PRA for the year. For eligible services, the Provider Fee is applied, then any remaining PRA, and finally the Co-Share is applied up to the Co-Share limit.

Provider fees are not required for Impact members on the Senior Program, as Impact is secondary to Medicare.