Under an 80/20 plan, if a participating provider's usual charge is $200 for a procedure and the allowed amount is $150, the provider can collect:
A) $150 from the insurance carrier and $50 from the patient.
B) $120 from the insurance carrier and $30 from the patient.
C) $120 from the insurance carrier and $80 from the patient.
D) $160 from the insurance carrier and $40 from the patient.

Question

Quizplus · Accepted Answer

Under an 80/20 plan, the insurance pays 80% of the allowed amount, which is $150 in this case, resulting in $120 paid by the insurance. The patient is responsible for the remaining 20% of the allowed amount, which is $30, not the difference between the usual charge and the allowed amount.

Under an 80/20 Plan, If a Participating Provider's Usual Charge