Which term reflects the portion of the bill that the third party does not cover?

Which term reflects the portion of the bill that the third party does not cover?

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

Answer: (B)

The concept here is cost-sharing between the patient and the insurer. A co-payment is the fixed amount the patient pays at the time of service, set by the insurance plan. This amount is not covered by the third-party payer in that encounter, and the insurer covers the remaining approved charges according to the plan. It’s the patient’s upfront share of the bill, separate from other possible amounts like coinsurance or deductibles that may apply later. Encounter describes the actual visit, not the payment portion. A procedure number is just the billing code used to identify the service. An Explanation of Benefits is the insurer’s statement showing what was paid and what the patient still owes after processing, not the specific share the payer does not cover in the moment of service.

The concept here is cost-sharing between the patient and the insurer. A co-payment is the fixed amount the patient pays at the time of service, set by the insurance plan. This amount is not covered by the third-party payer in that encounter, and the insurer covers the remaining approved charges according to the plan. It’s the patient’s upfront share of the bill, separate from other possible amounts like coinsurance or deductibles that may apply later.

Encounter describes the actual visit, not the payment portion. A procedure number is just the billing code used to identify the service. An Explanation of Benefits is the insurer’s statement showing what was paid and what the patient still owes after processing, not the specific share the payer does not cover in the moment of service.