In a BCBS EOB example, charged 100, allowed 80, deductible 40 applied, payer pays 80% of the balance. How much should the patient pay?

In a BCBS EOB example, charged 100, allowed 80, deductible 40 applied, payer pays 80% of the balance. How much should the patient pay?

• A. 48
• B. 60
• C. 40
• D. 8

Answer: (A)

Understand how deductible and coinsurance work with the allowed amount. The allowed amount is the portion the insurer will pay or reduce to; here it’s 80. The deductible of 40 is paid first, before coinsurance applies. After paying the deductible, 40 remains of the allowed amount. The payer covers 80% of that remaining balance, which is 32. The patient is responsible for the rest of the allowed amount, which is 8 (the remaining 40 minus 32). Add the deductible and the coinsurance: 40 + 8 = 48. So, the patient pays 48 in total.

Understand how deductible and coinsurance work with the allowed amount. The allowed amount is the portion the insurer will pay or reduce to; here it’s 80. The deductible of 40 is paid first, before coinsurance applies. After paying the deductible, 40 remains of the allowed amount. The payer covers 80% of that remaining balance, which is 32. The patient is responsible for the rest of the allowed amount, which is 8 (the remaining 40 minus 32). Add the deductible and the coinsurance: 40 + 8 = 48. So, the patient pays 48 in total.