Question

The patient has a policy that requires a $20 copayment for an in-network visit due at the time of service. the policy also requires 30 percent coinsurance from the patient. today’s visit charges total $785. after subtracting the copayment collected from the patient, the medical insurance specialist expects a payment of what amount from the payer? what amount will the patient be billed?

Answer 1

 

The question asks about the amount of payments AFTER the copayment from the patient has already been collected. Therefore the basis of our calculations should be the value of total charges subtracted with the copayment:

Total charges after copayment = $785 - $20

Total charges after copayment = $765

 

Since the insurance would be paying 70 percent of the total charges, therefore the amount to expect from the payer is:

Amount from the payer = 0.70 * $765

Amount from the payer = $535.50

 

Meanwhile, the policy requires coinsurance from the patient and he is to pay 30%, therefore the patient’s bill is:

Patient’s bill = 0.30 * $765

Patient’s bill = $229.50