Given an explanation of benefits showing billed amount $80, allowed amount $60, and patient copayment $20, which amount should be posted as the insurance payment?

Given an explanation of benefits showing billed amount $80, allowed amount $60, and patient copayment $20, which amount should be posted as the insurance payment?

• A. $40
• B. $60
• C. $20
• D. $80

Answer: (A)

The insurance payment is based on the allowed amount, with the patient’s responsibility taken out first. In this scenario, the allowed amount is 60 and the patient has a copayment of 20. The insurer pays the remaining portion: 60 minus 20 equals 40. The billed amount of 80 isn’t used to determine the insurer’s payment; it may be reduced to the allowed amount, and the copay remains the patient’s responsibility. So the amount posted as the insurance payment is 40.

The insurance payment is based on the allowed amount, with the patient’s responsibility taken out first. In this scenario, the allowed amount is 60 and the patient has a copayment of 20. The insurer pays the remaining portion: 60 minus 20 equals 40. The billed amount of 80 isn’t used to determine the insurer’s payment; it may be reduced to the allowed amount, and the copay remains the patient’s responsibility. So the amount posted as the insurance payment is 40.