A patient's charge for today's office visit is $68, of which $44 is allowable. The fee for the laboratory work is $82, of which $56 is allowable. If the patient has an 80/20 plan, which of the following amounts represents the insurance company's responsibility

Rationale

$80 represents the insurance company's responsibility.

In an 80/20 insurance plan, the insurance company covers 80% of allowable charges. For the office visit and laboratory work combined, the total allowable charge is $100 ($44 for the office visit and $56 for the lab work), making the insurance company's share 80% of this total.

A (20) YOUR ANSWER

This amount incorrectly represents 20% of the total allowable charges. The patient's responsibility under an 80/20 plan is 20% of the allowable fees, which is not the insurance company's responsibility.

B (80) CORRECT

This amount correctly reflects the insurance company's responsibility, as it is 80% of the total allowable charges ($100). Therefore, the insurance covers $80, leaving the patient responsible for the remaining 20%, which totals $20.

C (120) YOUR ANSWER

This amount is incorrect because it exceeds the total allowable charges. The combined allowable fees for both the office visit and laboratory work equal $100, making $120 an impossible figure based on the charges given.

D (150) YOUR ANSWER

Similar to option C, this amount is also incorrect because it is greater than the total allowable charges of $100. The insurance company's responsibility cannot exceed the total allowable amount for the services rendered.

Conclusion

In an 80/20 insurance plan, the calculation of the insurance company's responsibility is based on 80% of the total allowable charges. With the combined allowable amounts for the office visit and laboratory work totaling $100, the insurance company is responsible for $80, while the patient must pay the remaining 20%, which totals $20. This clearly illustrates how an insurance plan delineates financial responsibilities between the patient and the insurer.

A patient's charge for today's office visit is $68, of which $44 is allowable. The fee for the laboratory work is $82, of which $56 is allowable. If the patient has an 80/20 plan, which of the following amounts represents the insurance company's responsibility

$80 represents the insurance company's responsibility.

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