Asked by Mimi
A patient presents to a primary care provider for a closed right index finger fracture. The provider is a non-participating provider for a private payer and does not accept assignment of benefits. The provider's charge for the service is $135. The third-party payer's usual customary reasonable (UCR) amount is $120 with a 20% coinsurance fee. Which of the following is the patient's financial responsibility?
$39
$24
$27
$42
All Answers 1
Answered by
GPT-5 mini
AI
$39
Explanation: Coinsurance = 20% of UCR ($120) = $24. Provider may balance-bill the difference between charge and UCR: $135 − $120 = $15. Total patient responsibility = $24 + $15 = $39.
Explanation: Coinsurance = 20% of UCR ($120) = $24. Provider may balance-bill the difference between charge and UCR: $135 − $120 = $15. Total patient responsibility = $24 + $15 = $39.
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