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How to Calculate Patient and Payer Responsibility (Copay vs Coinsurance vs Deductible)

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Comments How to Calculate Patient and Payer Responsibility (Copay vs Coinsurance vs Deductible)

Can you enlighten me with this one? brbrThis is an example from our training Heres the only information provided including the questions Thank you so much in advance brbrScenario: Mark has an insurance policy with 100 Usd monthly premium , a 1000 USD deductible and a 5000 USD out of pocket maxim He broked his leg and got a hospital bill of 10000 usd , how much of this bill he has to pay? brbrHow much is total expenses of mark considering his deductibles and out of pocket? brbrHow much of total expenses will be covered by the insurer? Comment from : Kenneth Roxas

WOW I understand that awesome THANK YOU Comment from : keyshia norman

That was really helpful My job, which is adjustment, is for a hospital I'm being trained by someone who isn't very helpful Since he has been employed by the company for more than 8 years, he is qualified to examine the account and determine where adjustments are required Contrary to me, who comes from a nursing home and handles private billing, this is completely foreign to me I'm not sure whether you can help with this, but if you can, that would be really appreciated Comment from : Gena Gibson

Hi Comment from : Sham Kumar

So helpful! Thank you! Comment from : Julie Rodriguez

Hello I am currently in the Medical Billing part of my online Medical Coding Course Learning who pays first when multiple agencies invilved Trying to understand why all don't charge the same and pay the same Comment from : Bern Fran

My textbook could never😭😭 Thankyou Comment from : Mbali Mpasa

This is a great video It just leaves one question what happens to the adjustment amount? Does the patient has to pay this as I assume it was billed to the patient and the insurance reimburses only the of the allowed amount? Thank you for your advice Comment from : Andrea Bruns

Interesting Comment from : Bern Fran

You are doing the lord’s work, this is the first time it had made sense, big THANK YOU!!! ❤ Comment from : meowser7

Hii Qiana i want to work in USA as a biller I'm working in India as a biller m a senior Account receivable i am 23 and i know about the denials RCM i worked in some software's can u help me to know how do join or work in USA as a biller Comment from : Sandeep Jaiswar

Example 4 is this a scenario when a patient don’t have an ded but have an OOP with a coinsurance? Comment from : nj

So example 3 the adjustment is $260 this giving be written off? brBecause the patient is only responsible for paying the $330 allowed amount due to not met their ded? Comment from : nj

Why is insurance reimbursement have less amount,, and patient responsible have more amount Comment from : Shaik Ibrahim

thank you thank you thank you! I'm currently taking an online medical billing/coder class and I was super lost! I can tell you love what you do and this gives me inspiration to keep going and not give up on this class Comment from : Tina Graham

Omg thank you so much you're life saver❤❤❤❤ i was wondering when billing do they give you sme kind of network to work on when your hired to work? or do we find that our selves Comment from : Cosmic Wonderland

Plz more sample so if they have a 2000 deductible in network and have a copay of 25 dollar they pay 25 everytime they come in correct Comment from : Ivette Reyes

I love the way you break this down Comment from : Restore Her VI

I have a question pertaining to how the provider is payed If a patient has a large deductible, does the reimbursement go to the provider or is it the patients responsibility to pay the provider We have cases where the patients deductible was payed down and the provider received nothing Comment from : Totality Info

THIS VIDEO WAS SO HELPFUL THANK YOU!!! Comment from : LoveMagnet

What do you mean by allowed amount? Comment from : Dana

This was great! Comment from : mockingjaye

very helpful I go to externship in a few days and this was my weakness I'm glad their letting me bring notes Comment from : I Z E Y A H

Thank you so much!!!! Comment from : simryusom8811

Thank you for sharing this video I just started my MOA class on billing and felt lost I'm interested in learning more in all the medical fields Comment from : Julie Ramirez

Thank you! Comment from : celibatairepapillon

You are amazing! I made up my own numbers and followed your guide for ea example I'll need to know how to calculate for my job God bless you ❤️❤️ Comment from : DJM

How would you calculate example 5 if they had not yet hit their out of pocket maximum but the patient responsibility of $4588 would put them over their out of pocket maximum? Comment from : Shandy Sawyer

Understood!! Comment from : Natacha Harrison

How do you calculate the patient out of pocket amount when there is a secondary insurance? In this case Medicare is primary and the secondary has a 10 coinsurance You’re the best! Comment from : Anna Disney

I just finished my Administrative Medical Assistant course and i learn about medical billing and coding, you explained it very easy Can you please provide me with the zoom information about yure class Comment from : Melisa Marquez

I am a registration clinic I understand the copay part but when it comes to what the patient owes before they see the doctor with a deductible that's either met or not bet how do you figure their cost Comment from : Michaelene Macke

Hello good evening I did Medical Billing years ago and would like a refresher course as I started a new job that includes medical Billing How can I be a part of your class Comment from : Antonia Antonia

Referreing to Example #5: Is the "Provider" able to keep the unmet deductible plus what was covered by the insurance? So the total income received is $5866 Did I get that correct? Thank you so much Comment from : Alicia Rebecca

Hi Quiana, thank you so much for this video it's very helpful Hope you can make a video on how to read the EOB God bless Comment from : Gina Pitalco

I have one question,annual deductible limit :250$,brcoinsurance :500$,Allowed amount was :400$Ex :80after deductible 20copay for office visit,pls help me Comment from : Sridhar Sridhar

Hi I'm new to your channel and I love your videos Thank you so much for making such informative videos brbrWas just wondering what happens to adjustments? Is the amount the provider is willing to let go? Or should this be including for ptx oops? Thank u in advance More power! Comment from : Jane Anne Montenegro

Do you help tog et medicalbilling work ? Comment from : Mission Infotech

I love your video too!! what about out of network benefits? Comment from : Leticia Acosta

Hi, my question is: If the patient has a primary and secondary Insurance The primary deductible is 1,000 and has not met Do you bill the secondary Ins Prior to collecting the primary deductible? Ty in advance your video was excellent! Clare Comment from : Clare Pierce

How did you get the $40 copay on the first example??? Comment from : fuyit16

Thank you so much I was so confused with all of this before you The book we are using is very vague in describing how to calculate You are an angel Comment from : Stacey Licayan

Does the "No Surprises Act" affect the way you balance-bill patients? Is it still legal to balance-bill? Comment from : T O

Thank you for your video! I watched lots of videos about this topic and you clearly explained everything You're examples helped me a lot Thanks again! Comment from : Aggie

We are out of network provider , Can you do a video on that? Comment from : Liliana Martinez

This video is awesome !!! Do you still teach the class? I may be interested Comment from : Lisa Giovino

Thank you for the information I have a question…brHow is allowed amount calculated??brOn what factors does it depend? Comment from : Pranav Shrestha Nepali

I have 7 years of experience in medical billing and revenue cycle management I have experience in charge entry, payment posting and account receivable ( ar denials) brNow I am trying to get Doctors/ Clinic brfor billing business from UsbrbrCould you please help me to get Doctors/ ClinicbrbrRegardsbrThank you Comment from : A K Fitness

Thank you so much!!!!! Comment from : Shae Love

GREAT !!!!!!very useful video! this is such an underrated videopeople need to know all of this to survive in the US Comment from : Devisai R

are there any payment for the seminar? Comment from : Jaymark Juan

is there a video for the calculation with secondary insurance? Comment from : Facu Alvez

It's a really helpful for me Thanks 👍 Comment from : Entertainment ki duniya

this is great yu explain very well Comment from : MegaMermaidgirl

got a silly question i dont know if yu have employees or not but if yu want to take a vacation and yu r handling a providers billing do yu take your laptop with yu so yu can get done? i think it was your channel where i heard yu have a certain amount of time to file a claim Comment from : MegaMermaidgirl

you are a life saver !!!!!!!!!! Comment from : SS8

Enjoyed the video I hope you can do more on the calulationsYou made it easier to understand Comment from : BahaCurls Lovee

Loved your video! I just have a few questions about medical billing: firstly, is it possible to get into medical billing in a behind-the-scenes role? I'm interested in the field but would prefer a role that's not front desk Also, do employers train you in understanding the insurance guidelines? Comment from : Joseph Page

How to know or compute specific deductible per service? Example, deductible is $6500/plan year, patient will have $300 xray service, how much is the deductible and how much for insurance reimbursement on this specific service? Asking from PH, thanks! 💜💜 Comment from : stvn rnzl

Oh my gosh I love you!!!!!!!! I finally get it now I am taking my medical and billing coding exam for the 2nd time on friday You are so so helpful I will be watching you videos Comment from : Angela Griner

Thank you lady! I agree with the previous notes this was spot on and very clear Comment from : Felicia Coleman

Hi, please assist me on this to resolvebrbrAs per the contract Insurance will pay the 90 Calendar Year Deductible is $300Calculate the Paid Amount, Patient Responsibility and the Provider is Participating Comment from : Sanjana Rawat

wish it was in lamens terms Comment from : Know YouDidnt

How much is the 6 weeks course? Comment from : Linda Bradley

How do you get the allowed amount please and thank you? I'm taking a class and I'm so confused Your video did help much more than my instructor 🤦🏽‍♀️🙏🏼 Comment from : coco_puff_kit

Whatttt you can schedule a consultation I NEED THAT WITH You!!! Comment from : jacky espinoza

Hey Quiana,brCan you do a video on how does the provider credentialing work Like, when we receive rejections from clearing house that the provider is not on file Or the provider contract is expired?? How do we resolve those kind of rejections/denials Comment from : meghana bns

This is so helpful I understand it way better this way I went to school for medical office and billing specialist last, completed the course but do work in the field because I didn’t quite understand what I was doing but you have explained this wonderfully I now have confidence to take the exam and get off into the field Really wish there was some out there that could explain coding like this Comment from : Changingher23

Thank you so much for this video and the time you put into it, to share with us all! It's so much appreciated! Comment from : Mistii Page

Awesome 👍 Comment from : Pranav Panchal

Hi, thanks for this informative video! I have a question tho,, Can copays, deductibles, and coinsurance vary per service? Thanks in advance Comment from : Faith Steph

Could you possibly do a video on patient insurance eligibility/verification please? Comment from : Analogfog

I can’t stop saying thank you for these vids! Comment from : Analogfog

Very informative video ma'm you reminded me the stuff i forgot It's been a long time to left medical billing On monday I'm gonna face HR for medical biller Comment from : Tahir Raza

Only 10 comments for this very precious video I think still people don't know about medical billing or i think 90 of people They became owners of individual medical billing company 😁🤣 Comment from : Tahir Raza

Thank you so much; this video is exactly what I neededI’ve scheduled a consultation with you later this month to get additional help in this areayou’re videos are very helpful, Thanks again 👏🏾👍🏾😌 Comment from : Shun P

Thank you so much very informative 👍 Comment from : Chelly

Thanks so much I needed this !! Comment from : Britney Harris

hello Comment from : Beracah Ministries Official

Awesome information sis! I like to stay versatile This brought back some things! I use to post payments! ❤️🙌🏾 Comment from : Coding With Amanda Chalk

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