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Visit # 2 : The patient is sent for routine annual blood work panel. The provider's normal fee for this service is $ 2 1
Visit #: The patient is sent for routine annual blood work panel. The provider's normal fee for this service
is $ The payer's fee schedule shows an allowed amount of $ The patient is not required to
pay a copay for this visit.
a Enter the amount of the patient's deductible at the beginning of this visit:
b Enter the amount the patient pays against their deductible for this visit:
c Enter the remaining amount owed to the provider: $
d Enter the amount of coinsurance to be paid by the patient: $
e Enter the amount of coinsurance to be paid by the payer: $
f Enter the TOTAL amount that is paid by the patient: $
g Enter the amount the provider "writes off" the account: $
h Enter the total amount the provider will be reimbursed for this service:
i Enter the amount of the patient's deductible at the end of this visit: $
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