The patient is seen by his family physician for follow-up treatment of recently diagnosed asthmatic bronchitis. The physician’s fee is $75. The patient’s copayment is $20. The patient’s insurance plan covers 80% of the fee schedule amount of $60. No deductible is required.
a. Enter the amount the patient pays the provider: __________________
b. Enter the amount the payer reimburses the provider: ______________
c. Enter the amount the provider “writes off” the account: ____________
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a. To determine the amount the patient pays the provider, we need to calculate the patient's portion of the fee after the insurance coverage.
First, calculate the fee after the insurance coverage:
Fee after insurance coverage = Fee schedule amount * Insurance coverage
Fee after insurance coverage = $60 * 80% = $48
Since the patient's copayment is $20, the total amount the patient pays the provider is the copayment plus the remaining portion of the fee:
Patient payment = Copayment + (Fee after insurance coverage - Copayment)
Patient payment = $20 + ($48 - $20)
Patient payment = $20 + $28
Patient payment = $48
Therefore, the amount the patient pays the provider is $48.
b. To determine the amount the payer reimburses the provider, we need to subtract the patient payment from the fee:
Payer reimbursement = Fee - Patient payment
Payer reimbursement = $60 - $48
Payer reimbursement = $12
Therefore, the amount the payer reimburses the provider is $12.
c. The amount the provider "writes off" the account refers to the difference between the fee schedule amount and the payer reimbursement:
Provider write-off = Fee schedule amount - Payer reimbursement
Provider write-off = $60 - $12
Provider write-off = $48
Therefore, the amount the provider "writes off" the account is $48.