Office Administrative Assistant Practice Exam

If the allowed amount is $80.00 for a procedure under an 80/20 coinsurance plan, what would be the coinsurance balance sent to the secondary insurance?

1. $8

2. $16

3. $20

4. $32

The correct answer is: $16

In an 80/20 coinsurance plan, the insurance company covers 80% of the allowed amount, leaving the insured responsible for the remaining 20%. To determine the coinsurance balance, first calculate the 20% that the insured must pay. For an allowed amount of $80.00, you can find 20% by multiplying $80.00 by 0.20: \[ 20\% \text{ of } 80.00 = 80.00 \times 0.20 = 16.00 \] Therefore, the balance of $16.00 that the insured is responsible for under this plan is the amount that would be sent to the secondary insurance for potential coverage. This is the correct amount that would be noted as the coinsurance balance in the billing process. The other options do not reflect the proper calculation based on the 80/20 split and thus do not represent the correct balance.