Calculating Commercial Insurance Reimbursement You work for a billing service. You have been assigned the duty of calculating what the patient owes and what the insurance company owes, so that you can determine what revenue to expect for these services. You have the charge and the usual, customary, and reasonable (UCR) amount. The reimbursement will be calculated on the 80/20 distribution. The deductibles for each of these patients have been met. Under this insurance plan, $20.00 copays are due for primary care physician office visits and $40.00 copays for specialists. There is no copay for other services. Use the data in Table 4-3 to calculate the coinsurance; amount insurance will pay; and how much the patient owes, including any copays. Table 4-3 is available on the student companion website for your use. Insurance Pays TABLE 4-3 Calculating Commercial Insurance Reimbursement Calculating Commercial Insurance Reimbursement Patient's Patient's Service Charge UCR Copay Coinsurance Internal medicine $120.00 $120.00 physician visit Physical therapy $150.00 $97.00 X-ray chest $115.00 $73.00 MRI chest $1,845.00 $1,147.00 Cardiologist physician $165.00 $90.00 visit Dermatologist physician $75.00 $70.00 visit Lab test $32.00 $19.00 Lab test $45.00 $29.00 Mammogram $151.00 $95.00 Calculating Commercial Insurance Reimbursement You work for a billing service. You have been assigned the duty of calculating what the patient owes and what the insurance company owes, so that you can determine what revenue to expect for these services. You have the charge and the usual, customary, and reasonable (UCR) amount. The reimbursement will be calculated on the 80/20 distribution. The deductibles for each of these patients have been met. Under this insurance plan, $20.00 copays are due for primary care physician office visits and $40.00 copays for specialists. There is no copay for other services. Use the data in Table 4-3 to calculate the coinsurance; amount insurance will pay; and how much the patient owes, including any copays. Table 4-3 is available on the student companion website for your use. Insurance Pays TABLE 4-3 Calculating Commercial Insurance Reimbursement Calculating Commercial Insurance Reimbursement Patient's Patient's Service Charge UCR Copay Coinsurance Internal medicine $120.00 $120.00 physician visit Physical therapy $150.00 $97.00 X-ray chest $115.00 $73.00 MRI chest $1,845.00 $1,147.00 Cardiologist physician $165.00 $90.00 visit Dermatologist physician $75.00 $70.00 visit Lab test $32.00 $19.00 Lab test $45.00 $29.00 Mammogram $151.00 $95.00