Given billed $170, allowed $150, deductible unmet $50, copayment $20, what is the patient’s responsibility?

Given billed $170, allowed $150, deductible unmet $50, copayment $20, what is the patient’s responsibility?

• A. $50
• B. $20
• C. $70
• D. $100

Answer: (C)

The main idea is how patient cost-sharing works with the allowed amount. Use the allowed amount (not the billed amount) to determine what the insurer and patient owe. Since the deductible is unmet, the patient must pay the full deductible amount first, which is 50. The copayment of 20 is an additional fixed amount the patient pays at the time of service. Add these together: 50 + 20 = 70 for the patient’s responsibility. The insurer would then pay the remaining portion of the allowed amount: 150 minus 70 equals 80. So the patient’s total responsibility is 70.

The main idea is how patient cost-sharing works with the allowed amount. Use the allowed amount (not the billed amount) to determine what the insurer and patient owe. Since the deductible is unmet, the patient must pay the full deductible amount first, which is 50. The copayment of 20 is an additional fixed amount the patient pays at the time of service. Add these together: 50 + 20 = 70 for the patient’s responsibility. The insurer would then pay the remaining portion of the allowed amount: 150 minus 70 equals 80. So the patient’s total responsibility is 70.