Based on the information given for this indemnity plan, what is the patient’s out-of?pocket responsibility for this service?

Question

a. $ 8.00
b. $18.40 RATIONALE: $18.40 is the difference between the standard fee and the UCR-approved fee plus the coinsurance amount.
c. $10.40

Study the following situation, then answer questions 11 and 12. The patient has an indemnity plan and the physician does not have a contract with the health plan.

Physician standard fee (billed to insurance): $ 60.00
Insurance UCR/approved: $ 52.00
Insurance paid 80%: $ 41.60
Coinsurance: $ 10.40

Answer 1

b. $18.40 RATIONALE: $18.40 is the difference between the standard fee and the UCR-approved fee plus the coinsurance amount.