An explanation of benefits states the amount billed was $80, the allowed amount is $60, and the patient is required to pay a $20 copayment. Which of the following describes the insurance check amount to be posted?

An explanation of benefits states the amount billed was $80, the allowed amount is $60, and the patient is required to pay a $20 copayment. Which of the following describes the insurance check amount to be posted?

• A. $60
• B. $20
• C. $40
• D. $80

Answer: (C)

To determine the insurance check amount to be posted, it is essential to understand the components of the billing process as reflected in the explanation of benefits (EOB). In this scenario, the provider billed $80 for the service. However, the insurance company has determined an allowed amount of $60 for that service, which is the maximum amount they will reimburse the provider. The patient has a copayment, which is an out-of-pocket expense that the patient is responsible for at the time of receiving care. In this case, the copayment is $20. To calculate the net insurance payment, you take the allowed amount of $60 and subtract the patient’s copayment of $20. Therefore, the insurance will pay: $60 (allowed amount) - $20 (copayment) = $40. This amount, $40, is what the insurance check will cover and is the sum that should be posted in the accounting records. Hence, the correct answer accurately reflects the amount the insurance company will pay to the provider after the copayment is considered.

To determine the insurance check amount to be posted, it is essential to understand the components of the billing process as reflected in the explanation of benefits (EOB). In this scenario, the provider billed $80 for the service. However, the insurance company has determined an allowed amount of $60 for that service, which is the maximum amount they will reimburse the provider.

The patient has a copayment, which is an out-of-pocket expense that the patient is responsible for at the time of receiving care. In this case, the copayment is $20.

To calculate the net insurance payment, you take the allowed amount of $60 and subtract the patient’s copayment of $20. Therefore, the insurance will pay:

$60 (allowed amount) - $20 (copayment) = $40.

This amount, $40, is what the insurance check will cover and is the sum that should be posted in the accounting records. Hence, the correct answer accurately reflects the amount the insurance company will pay to the provider after the copayment is considered.