How do I Take Coinsurance Penalty on an Insurance Claim?
- 1). Evaluate if co-pays and deductibles are required and have been met by the member. Some policies also require co-pays and deductibles to be paid prior to or in conjunction with applying a coinsurance penalty.
- 2). Determine the policy's coinsurance percentage. Member coinsurance percentages can range from 10 to 50 percent per medical claim. This information must be accurate in calculating the member and insurance company's responsibilities.
- 3). Review the physician's charges on the medical claim after applicable deductions from fee schedules. Medical provider claims are typically reduced according to what the insurance company believes is reasonable to pay for these charges. The reduction is passed on to the member and insurance company when sharing in the responsibility of the medical claim.
- 4). Multiply the coinsurance percentage required in the policy by the reduced medical claim amount. If the medical after all deductions is $250 and the coinsurance percentage is 20 percent, the member is responsible for $50 of this medical claim.
- 5). Repeat the above steps for all medical claims received.
Source...