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