Override Copay Eligibility in Osmind

Last updated: July 15, 2026

This guide walks through how to manually override a patient's copay eligibility in Osmind, such as when insurance verification needs a manual adjustment.

Why the copay estimate can be off

Osmind's copay estimate is only as current as the information returned by the insurance payer, so a few common situations can cause it to differ from what's on the patient's card:

  • Recent plan changes: If a patient's plan renewed or their benefits changed recently, the payer's system may not have updated yet, so Osmind pulls slightly outdated information.

  • Behavioral health carve-outs: Some plans carve out behavioral health to a separate vendor (for example, Optum or Carelon). In these cases, the main medical plan's eligibility response may show a copay that doesn't actually apply to the services being billed.

  • Coinsurance or deductible-based plans: Some plans use coinsurance after a deductible instead of a flat copay, so the patient's actual responsibility depends on where they are in their deductible and plan year — something an automated estimate can't calculate precisely.

  • Accumulator lag: Deductible and out-of-pocket accumulators update on a delay. If a patient has had recent visits with other providers, those charges may not be reflected yet, which can cause the estimate to overstate what they still owe.

If a patient says their copay doesn't match their insurance card, it's usually due to one of these reasons — and it's a good sign that a manual override is needed.

Steps

  1. Open the Osmind Dashboard.

  2. Search for the patient.

  3. Click View Profile.

  4. Click Add tag.

  5. Click Apply Tag(s).

  6. Select manualVerification.

  7. Click Apply Tag.

  8. Scroll down to Insurance eligibility under the Overview section.

  9. Click Edit.

  10. Under Medical, update the Copay ($).

  11. Review and update the Telemedicine copay, then input the correct Copay ($).

  12. Click Save.

That's it — the copay eligibility override is complete and saved to the patient's record.

Reviewing overrides at the start of a new plan year

Since most insurance benefits reset annually, it's a good practice to periodically pull a report of patients with the manualVerification tag. This lets you re-check their insurance eligibility for the new plan year, remove the tag if it's no longer needed, and re-run or re-enter the correct copay information going forward.

If you have any questions about this process, reach out to your Customer Success Manager or the Osmind support team.