Question

Gary Tuttle has Citiwide Insurance with 100% coverage after a $25.00 copay on office visits. His services today include an office visit ($62.00), urinalysis with differential ($65.00) and a Treadmill ECG ($155.00), which were billed to his insurance company. The insurance approved/allowed $255.00 and paid 100% of the approved/allowed amount minus the copay already paid by the patient; answer the following:
11. How much is the copay? __________________________
12. How much is adjusted? __________________________
13. How much is the payment from the insurance company? ___________________________

Answer 1

11. COPAY

COPAY can be defined as the amount which the person that was been INSURED by the insurance company which is Gary tuttle paid to the insurance company (Citiwide Insurance) for insurance coverage.

Hence, the amount of COPAY will be $25.00 COPAY on office visits which was 100% paid.

12. ADJUSTMENT

Using this formula

Adjustment= (Office visit+Urinalysis+Treadmill ECG)-(Insurance approved/allowed+Copay)

Let plug in the formula

Adjustment=($62+$65+$155)-($255+$25)

Adjustment=$282-$280

Adjustment=$2.00

13. PAYMENT

The payment from the insurance company will be $255 which represent the INSURANCE APPROVED/ALLOWED by insurance company which was 100% paid.

In conclusion the copay amount is $25, Adjustment is $2.00 and the payment from the insurance company will be $255.

Learn more about INSURANCE here:

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