Correct on both counts probably. Are you telling me that there are clinics that can change your copay? I have definitely never heard of this. Any examples of insurance that only charges "a few dollars"? I have never seen one. ALL clincs have a sliding scale that i have delt with. They call it different things in my experience. Like for people who cant pay, they charge it off. For people that have insurance, they have negotiated rates... this basically means they charge what ever rate they can come to an agreement with the insurance. If the insurance wont pay that rate and the clinic isnt willing to take a loss on what they think they should make, the bill the customer for the extra. There is another type of customer that doesnt have insurance, but can pay, and in that case they chage them a discounted rate and sometimes offer payment plans. I am not aware of any sliding scale structure... no medical facility i have ever been in has a posted rate schedule and some way of discounting it based on income level... it is always what they think they can get out of you.