Patient Payment Calculation for Insurance Coinsurance

Question:

You work at a dermatologist’s office. The figure below illustrates the insurance card that a patient presents. The patient has met their deductible and has 20% coinsurance. The allowed amount for the service is $150. How much will the patient need to pay? Show your work.

Answer:

To determine how much the patient will need to pay, follow these steps:

1. Understand the Terms:

Deductible: The amount the patient must pay before the insurance coverage kicks in. Since the patient has met their deductible, they do not need to pay any more towards it.

Coinsurance: The percentage of the allowed amount that the patient must pay after the deductible has been met.

Allowed Amount: The maximum amount that the insurance company will cover for the service.

2. Calculate the Coinsurance Amount:

Given:

Coinsurance rate: 20%

Allowed amount for the service: $150

The formula for calculating the coinsurance amount is: Coinsurance Amount = Allowed Amount x Coinsurance Rate

Substitute the given values: Coinsurance Amount = 150 x 0.20

Coinsurance Amount = 30

3. Determine the Patient’s Payment:

Since the patient has met their deductible, they only need to pay the coinsurance amount.

So, the amount the patient will need to pay is $30.

Summary:

The patient will need to pay $30 for the service, based on the 20% coinsurance rate on the $150 allowed amount.