What is meant by a plan discount

Reference no: EM133729094

Problem

You are working in the billing department for a clinic when a patient calls, asking why she was sent a bill for $120. She explains it was her understanding she only had a $30 copay and does not understand why she now owes more. She has her Explanation of Benefits but does not understand it. She asks a series of questions. You review the patient's verification of benefits and the claim information. You note the following: The patient has an office visit copay of $30. The patient has a deductible of $500, with $400 previously met. The patient used an in-network provider, and the plan pays 80% while the patient pays 20%. What is meant by a plan discount? Does the patient have to pay the difference between the amount charged and the allowed amount? If the patient has 20% coinsurance, why does she have to pay $120 for the chest X-ray? Explain in detail.

Reference no: EM133729094

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