Question

The amount due from the patient for covered services from a nonparticipating provider is

A. the difference between the physician's fee and the deductible plus copayment.
B. the difference between the allowed charge and the physician's fee plus any coinsurance or copayment.
C. the difference between the deductible and the copayment.
D. the physician's fee plus copayment and a deductible.

Answer 1

The patient owes the difference between the allowed charge and the physician's fee plus any applicable coinsurance or copayment after meeting their deductible. The correct option is B.

Step-by-step explanation:

The amount due from the patient for covered services from a nonparticipating provider would be the difference between the allowed charge and the physician's fee plus any coinsurance or copayment.

This means that if the insurance company determines an allowed charge for a service, and the physician's charge is higher, the patient is responsible for the difference plus any fixed copayment or percentage-based coinsurance associated with their policy.

Deductibles must also be considered, which is the amount the policyholder pays out-of-pocket before the insurer pays for services.