Help With Patient Coinsurance and Deductible Responsibility

by k
(okc)

A patient (name removed to protect privacy) receives an amputation of the leg below the knee ($2,750), of which $2,750 is considered UCR. Patient’s coinsurance is 10%. Deductible is $100. She has previously satisfied $50.25 of her deductible. Doctor accepts assignment. What is the Patient’s portion?


Answer:

Since the patient has already satisfied $50.25 of the $100 deductible, $49.75 of the deductible remains. So this $49.75 will be applied to the UCR charges:

$2750 - $49.75 = $2700.25

Now that the deductible is satisfied, the coinsurance is applied to the remaining amount of $2700.25:

Coinsurance = 10% of $2700.25 = $270.03

So the total patient portion for this is:

Total = $49.75 + $270.03 = $319.78

Comments for Help With Patient Coinsurance and Deductible Responsibility

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Mar 30, 2013
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TRY TO UNDERSTAND
by: Anonymous

I'm sorry, i know that your are trying to help but
the answer does not make sense to me.
I don't understand you make.
this is the way i understand it.
I bill the pt
49.75 for deductible
and
275 for coinsurance
a total of
324.75
don't you have to show where is total is coming from?

Response:

Thanks for your comments. Coinsurance can be such a confusing topic. The reason I show it calculated the way it is above is I understand that for most policies coinsurance applies to the remaining balance after the deductible is applied - of course it may vary depending on the terms of your coverage. So it's important for patients to read and understand the fine print of their coverage.

Here's another explanation on coinsurance that may help.

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