Given a scenario with a $100 charge, $80 allowed, $40 applied to deductible, and payment of 80% of the remaining balance, what is the patient’s responsibility?

• A. $32
• B. $16
• C. $48
• D. $64

Answer: (C)

The calculation uses the allowed amount first, then applies the deductible, and finally coinsurance to the remaining balance.

Start with the allowed amount: $80. The deductible of $40 is applied to this, so the patient already owes $40, leaving $40 of the allowed amount for coinsurance. The insurer pays 80% of that remaining $40, which is $32. The patient is responsible for the remaining 20% of the $40, which is $8, plus the deductible already paid ($40). Total patient responsibility = $40 + $8 = $48.

That’s why the correct total is $48. The other numbers would result from not applying the deductible first or from applying coinsurance to the full allowed amount without accounting for the deductible.