Question

A patient's medical fees come to a total of $90 from a participating provider. What can you bill the patient if the

EOB lists the following itemization? Charges: $90, Not Eligible for Payment: $12, Allowed Charge: $78, Applied to
Deductible: $30, Copayment: $10, Amount Due from Carrier: $38.
A. $42
B. $40
C. $38
D. $30
E. $10

Answer 1

The patient can bill the amount due from the carrier, which is $38. Option C.

Step-by-step explanation:

The patient can bill the amount due from the carrier, which is $38.

First, we need to understand the itemization provided in the Explanation of Benefits (EOB). The Charges are the total medical fees incurred, which is $90. Not Eligible for Payment is an amount that the insurance company will not cover, in this case $12.

The Allowed Charge is the maximum amount that the insurance company will pay for the medical fees, which is $78. Applied to Deductible is the portion of the Allowed Charge that will be deducted from the patient's deductible, which is $30.

Copayment is the fixed amount that the patient is responsible for paying, which is $10. Finally, the Amount Due from Carrier is the remaining amount that the insurance company will pay, which is $38.

Since the patient is responsible for the Amount Due from Carrier, the patient can bill the insurance company for $38. so Option C.