How to calculate the patient liability for a medical bill? | From a Medical Billing Expert

[@sparham5205]

Thank you for taking the time to show us these examples of the calculation process. I am currently studying for my CPB exam and this really helps. This is the process where I seem to get lost. So again, thanks and I would love to see some more of these. I love your channel. Keep up the great work.

[@InleraU]

Yay! You're very welcome! I truly appreciate the feedback.

[@indiaequalityesports4654]

Thank you so much for your precious valuable time

[@InleraU]

You are so very welcome! :) Thank you for your comment.

[@MegaMermaidgirl]

thank yu it makes sense and yu explained it so that a patient inquiring about bill would understand. im looking into taking course and get certified for medical biller and get back into what i loved doing and did 14 yrs of medical admin

[@InleraU]

Yay! Welcome back :)) Thank you for your feedback!

[@bertan8510]

Thank you for these videos. It is so crazy that I have to wait to hope to get paid by insurance and then if the patient needs to pay then I have to wait for that too.

[@InleraU]

The process is nuts, isn't it? Thank you for watching!

[@rhondastewart6149]

Excellent video and explanations!

[@InleraU]

Yay - Thank you for the feedback! :-))

[@melissasippy6629]

I struggle to know when a payer is going to apply a copay versus coinsurance. Which can make it hard to give an accurate estimate. Running benefits on the payer will often show a copay and coinsurance but how do I know which applies to which CPT code? If they're going to only pay a copay for the visit or coinsurance for the allowed amount? I hope that makes sense..

[@Temachyotl33]

Very grateful for this education. The insurance companies make this confusing who knows why?

[@InleraU]

You're welcome! Insurance can be really confusing, for both patients and billers alike. That's why we made a course to help people better understand US Health Insurance: ips-s-school-8c86.thinkific.com/courses/Intro-to-US-Health-Insurance

[@wannabenatural2012]

Hi, new subscriber here. I have an interview at 4pm today for a charge entry specialist. I have no idea what to do or say. Thanks for explaining copay and co ins. I had this question asked in an interview two weeks ago.

[@InleraU]

HIiWanna! How was your interview?

[@pamelanichols5879]

Thank you for clarifying this up. I do have an additional issue when it comes to seeing a disputed amount. I'm not weather to bill the patient or write it off if no secondary insurance. I work in a chiropractic office now and I multitask all day and it has gotten me in trouble. Yes I had left me not being able to ask the same question beyond two.

[@InleraU]

I'd be very cautious with writing it off, if it is anything other than a CO45 (contractual adjustment), without prior approval from your boss. Any denial is going to come with a code on the EOB, and if your boss says you can write it off then you can go ahead and save it for reference in the future.

[@tigerbee0719]

You are the nicest! Please continue making these videos. You are a great help❤❤

[@InleraU]

Thank you so much! We absolutely will ❤️

[@princessbejai3276]

Thank you

[@InleraU]

You're welcome!

[@aggie9067]

Can you also make a video about "Out-of-pocket-maximum". Thank you!

[@InleraU]

Great suggestion! I have added it to the list. Let me know if you have any other ideas of topics you would like addressed.

[@Hsing9617]

Thanks for solve my confusion please upload vedio of takback refund

[@InleraU]

Yes, sure. Were you looking for that information from the Patient side or the payer Perspective?

[@mdowling835]

i struggle with how to arrive at the numbers i need for the patient to pay and how much the payer pays

[@meltdownman1]

I live in the State of Washington. It has Regence and Premera. Since they are both associated with Blue Cross Blue Shield what is the difference between the two? Any advantage of one over the other? Love these Vids!

[@InleraU]

Yay! So happy you are finding value! They are two separate companies that license BC/BS and each "own" different areas of Washington state. In addition to Washington St. Premera also services Alaska and Regence also services areas of Idahos. Other than that they are both BCBS carriers and will have competitive plans but they are not permitted to sell plan with Zips assigned to the other companies region. I hope that makes sense.

[@susankeen2216]

Hi Jasmine! Have you come across situations where the visit was subject to both a copay and coinsurance?

[@InleraU]

Yes, quite often especically in practices especially where two separate benefits could apply. For example, there may be a copay for the ortho exams (E&M) and a coinsurance for physical therapy. Does that help?

[@dafnaahdoot934]

When do you check for a coinsurance responsibility? Before the patient gets the service (so they pay it at the beginning ?) or do you process the insurance and then charge the patient ?…if we don’t know what the allowed amount I’m he saying it’s after we get the EOB

[@InleraU]

Thank you for your comment! There’s not really a one size fits all when it comes to coinsurance calculations. It would depend upon the specialty of your practice, and how often, in advance of the patient going back for care, you know exactly what the provider is intending to do with the patient. If it is an unknown until after the patient has been care for then you may have to wait until check out.

[@marlenahawkins7098]

I’m a medical billing and coding student, and I have 22 years in health care . I have seen so many medical centers have to take write off

[@InleraU]

Yes, indeed, so many losses in healthcare caused by the complexity and confusion.

[@Travelmynature]

maam it would be easier to understand if u can show the calculation on the side for both blue and green examples that u have shared. would wait for ur reply

[@InleraU]

That is great feedback, Game Techie!! I will definently do that in my next video on this or similar topics. You rock! :)

[@Travelmynature]

@@InleraU thanks!! Would be waiting for the next video

[@chim559]

Hai can you explain the responsibility and the role of Refund adjudication department ?

[@InleraU]

Hello, can you clarify are you refereing to refunds for payments owed from the provider/practice to the insurance payer?

[@pandurangbhat9615]

For example billed amount 500 allowed any 250 so provider only get 250 right. Where does the remaining 250 goes

[@InleraU]

If the provider is in-network (contracted) with the insurance. It gets written off as a contractual adjustment. They cannot bill the patient. If they are not in-network the practice/provider can balance bill the patient for the remaining balance.

[@joanng3009]

@@InleraU how does a new biller know if the company is in network or out of network?

[@purplelover9633]

@@joanng3009your company should let you know

[@syedarbaz5005]

Hi I am Medical biller from India I have a specific questions "why Medicare does not pay to the out of network provider for Medically ER service ?

[@InleraU]

Hello! Not sure I can answer that without knowing more claim detail.

[@fuyit16]

How will I know how much the co pay for a medicare part b insurance?

[@InleraU]

Medicare always has a 20% coins for Part B. Here is a resource that should help: www.medicare.gov/basics/costs/medicare-costs

[@janespitfire9884]

Right now lots of billing fraud occurring mostly by hospitals will over bill same lab or increase OP visit to more than 75%. Thus the patient has to pay if not aware.

[@InleraU]

Thanks for your comment! Yes, it's quite unforntunate that patients do not always know when to question as the statements can lack detail or be confusing.

[@panouleex]

i have some questions about your course but cannot seem to find an email to directly contact you.

[@InleraU]

We have had the course on hold but we will be restarting in the coming weeks so stay tuned.

[@robyngann1570]

So the provider has to write off the $250.00 that wasn’t allowed?

[@InleraU]

Hi Robyn! I am responding to this comment video video that will be up on the channel shortly, so please stay tuned!

[@InleraU]

What happens to the other $250 if the bill amount is 500?

[@tracydaprince]

could someone have a deductible and a copay?