Which term describes the portion of the cost of each service that the patient pays—the share not covered by the third party?

Which term describes the portion of the cost of each service that the patient pays—the share not covered by the third party?

• A. Encounter
• B. Co-payment
• C. Procedure number
• D. Explanation of benefits

Answer: (B)

The main idea here is how patients share the cost of care with insurance. The term that describes the fixed amount a patient pays at the time of service, regardless of the total charge, is the co-payment. This is the patient’s portion not covered by the insurance, paid directly to the provider when you receive the service. The rest of the cost may be covered by the insurer according to the plan. Different from a co-payment, coinsurance is a percentage of the allowed charge the patient pays after any deductible has been met, and a deductible is the amount the patient must pay out-of-pocket before the insurer contributes. The other terms refer to different things: an encounter is the actual visit, a procedure number is a billing code, and an Explanation of Benefits is the insurer’s statement detailing what was paid and what the patient owes afterward, not the amount due at the visit.

The main idea here is how patients share the cost of care with insurance. The term that describes the fixed amount a patient pays at the time of service, regardless of the total charge, is the co-payment. This is the patient’s portion not covered by the insurance, paid directly to the provider when you receive the service. The rest of the cost may be covered by the insurer according to the plan.

Different from a co-payment, coinsurance is a percentage of the allowed charge the patient pays after any deductible has been met, and a deductible is the amount the patient must pay out-of-pocket before the insurer contributes. The other terms refer to different things: an encounter is the actual visit, a procedure number is a billing code, and an Explanation of Benefits is the insurer’s statement detailing what was paid and what the patient owes afterward, not the amount due at the visit.