In-network and has met $450 of their $500 deductible. Insurance covers 80% of chiropractic care after the deductible is met. The doctor performs an adjustment and 1 unit of manual therapy. Adjustment $40 and the manual therapy $60. How much does the patient owe for this visit?

In-network and has met $450 of their $500 deductible. Insurance covers 80% of chiropractic care after the deductible is met. The doctor performs an adjustment and 1 unit of manual therapy. Adjustment $40 and the manual therapy $60. How much does the patient owe for this visit?

• A. $10
• B. $20
• C. $100
• D. $60

Answer: (D)

The main idea is how a remaining deductible interacts with after-deductible coinsurance. Here the patient has $50 left to meet of a $500 deductible. The visit costs $100, so the patient first pays the remaining deductible amount: $50. After that, $50 of charges remain eligible for insurance at 80% coverage, leaving $40 paid by the insurer and $10 as the patient’s coinsurance. Add the deductible paid ($50) to the coinsurance ($10) and the patient’s total responsibility for this visit is $60. The insurer would coverage $40.

The main idea is how a remaining deductible interacts with after-deductible coinsurance. Here the patient has $50 left to meet of a $500 deductible. The visit costs $100, so the patient first pays the remaining deductible amount: $50. After that, $50 of charges remain eligible for insurance at 80% coverage, leaving $40 paid by the insurer and $10 as the patient’s coinsurance. Add the deductible paid ($50) to the coinsurance ($10) and the patient’s total responsibility for this visit is $60. The insurer would coverage $40.