Insurance & Eligibility · Eligibility
Coinsurance Information #
Coinsurance is a percentage of an allowed amount that may become patient responsibility after payer rules are applied.
What to do #
- Review the coinsurance percentage returned for the relevant benefit.
- Confirm the network or benefit context when the response provides it.
- Do not multiply the percentage by the billed charge and assume that is the final amount.
- Use the information according to practice front-end policy.
Verify before you finish #
- The percentage applies to the relevant service category.
- In-network and out-of-network values were not confused.
- The value is not represented as final adjudicated responsibility.
Important
Coinsurance is usually applied to the payer’s allowed amount, not necessarily the practice’s billed charge.