Office Administrative Assistant Practice Exam

A patient with a 70/30 insurance plan has an allowed amount of $200.00. How much will be sent to the secondary insurance?

1. $40

2. $60

3. $80

4. $120

The correct answer is: $60

To determine how much will be sent to the secondary insurance, it's important to first understand how the allowed amount and the copayment percentages work. In this scenario, the allowed amount is $200. The patient's insurance plan covers 70% of the allowed amount, while the patient is responsible for 30%. Calculating the coverage that the primary insurance will pay: - 70% of $200 is calculated as follows: \( 0.70 \times 200 = 140 \) This means the primary insurance will pay $140 of the allowed amount. Now, we need to calculate the patient's responsibility, which is the remaining 30%: - 30% of $200 is calculated as follows: \( 0.30 \times 200 = 60 \) This means the patient is responsible for $60, which is what they need to pay out-of-pocket. However, when considering the secondary insurance, it typically may cover the patient’s out-of-pocket costs not covered by the primary insurance, depending on the policy. In this situation, since the primary insurance has paid $140, the submission to the secondary insurance is commonly the portion that remains after the primary has paid, which refers to the patient's cop