Charge vs Allowed vs Reimbursed

How do I know what dollar amount is being paid?

Charge – this is the dollar amount put in box 24F on the HCFA claim form. This amount is your retail price.

Allowed – this is the dollar amount in the payer's fee schedule for this particular code. This is the dollar amount the payer will pay for this covered service.

Contractual Write-off – this is the difference between charges and allowed in the payers' fee schedule. You agree to accept the fee schedule allowed amount when you sign the contract with a payer. The difference between what you charge and allowed amount is a write-off. You are not able to bill the patient for the difference.

Patient Responsibility – the portion of the allowed amount the patient must pay. This may be coinsurance, copayment, or a deductible amount.
Here is an example of a payment to assist in understanding what payment is from the insurer and what payment is from the patient:

Charge - $1200.00
Allowed – $840.00
Contractual Write-off – $360
Patient Responsibility – $168.00
Paid from the Insurance Company – $672
You will receive $672 from the insurance company and collect $168 from the patient for a total allowed amount of $840.00

What does this mean for you?

Each EOB is different and may use various terminology. Take the time to review your EOB and understand where your money is coming from.