In the EOB scenario, billed amount is $170, allowed amount is $150, the deductible is $50, and the copayment is $20. What is the patient’s responsibility?

• A. $70
• B. $50
• C. $20
• D. $170

Answer: (A)

The patient’s responsibility is determined by the deductible and the copayment, applied to the allowed amount, with the insurance covering the remainder when no coinsurance is specified.

Here, the allowed amount is 150. The patient must first meet the deductible of 50, so 50 of the allowed amount is the patient’s responsibility. After meeting the deductible, the remaining allowed amount would typically be covered by insurance if there’s no coinsurance, leaving 100 to be paid by the insurer. Separately, the patient also pays a copayment of 20. Adding the deductible and the copayment gives 50 + 20 = 70 as the patient’s total responsibility. The insurer would pay the remaining 100 of the allowed amount.