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, and the patient is not required to pay any additional amount to the provider. The payer reimburses the physician $28

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reimburses? Did the doctor pay the patient something?

To understand how the reimbursement amount of $28 is determined, we need to consider a few factors.

1. Fee Schedule: Insurance companies have fee schedules that determine how much they will reimburse healthcare providers for specific services. These fee schedules are often based on a variety of factors, including the type of service, geographical location, and negotiation between the insurance company and the provider.

2. Allowed Amount: The allowed amount is the maximum amount that the insurance company will reimburse for a particular service. This amount can be lower than the actual fee charged by the provider. In this case, the allowed amount is $28.

3. Co-payment: A co-payment is a fixed amount that the patient is responsible for paying at the time of the visit. In this case, the patient's co-payment is $20.

Based on the information provided, let's break down the financials:

- The total fee charged by the physician is $75.
- The patient's co-payment is $20, which they pay directly to the provider.
- The remaining amount to be reimbursed to the provider is $75 - $20 = $55.

However, the insurance company only reimburses $28 to the provider, which is determined by their fee schedule and allowed amount.

So, the patient pays $20 in co-payment, and the insurance company reimburses $28 to the provider. The total financial responsibility for the patient is $20 + $55 (the amount not covered by insurance) = $75.