If a patient's office visit is billed at a higher rate than the allowed amount from insurance, what should the patient be charged?

In the context of billing and coding, when a patient's office visit is billed at a rate higher than what the insurance allows, the patient is typically responsible for the allowed amount as determined by their insurance policy. This means that even though the service may have been billed at a higher rate, the insurance company has a set amount that they are willing to pay for that service.

By charging the patient the allowed amount, it aligns with the agreements made between the healthcare provider and the insurance company. Providers often have contractual obligations that dictate how much they can charge patients for various services, ensuring fairness and compliance with payer guidelines. This protects patients from being overcharged beyond what insurance has deemed acceptable.

Charging the patient the allowed amount ensures that they are not responsible for the higher billed rate, which could create financial burdens that exceed what the insurance company is prepared to cover. Thus, the correct practice is to charge the patient based on the allowed amount rather than the total billed amount or simply the deductible alone.