Context: out-of-network office visits.
Say for example my allowed amount for a code is $100. The plan covers 80% of the allowed amount. My bill is $80. How does this work? There are a couple of ways I could interpret, and the internet isn’t helping here.
Since the plan covers 80% of the allowed amount, which is $100, then that means $80 is already covered. I owe $0. The plan covers 80% of any billed amount lower than the allowed amount. Since the billed amount is $80, I owe $16. The plan assumes all bills for this code are at the allowed amount, so I automatically owe $20 for the bill.
Thanks in advance!
submitted by /u/BlakeIsBlake
[link] [comments]Context: out-of-network office visits. Say for example my allowed amount for a code is $100. The plan covers 80% of the allowed amount. My bill is $80. How does this work? There are a couple of ways I could interpret, and the internet isn’t helping here. Since the plan covers 80% of the allowed amount, which is $100, then that means $80 is already covered. I owe $0. The plan covers 80% of any billed amount lower than the allowed amount. Since the billed amount is $80, I owe $16. The plan assumes all bills for this code are at the allowed amount, so I automatically owe $20 for the bill. Thanks in advance! submitted by /u/BlakeIsBlake [link] [comments]Read Morer/HealthInsurance