Health insurance question
March 10, 2014 10:03 PM Subscribe
What is the difference between "Allowed Amount" and "Co-pay" on an Explanation of Benefits?
posted by fozzie_bear to Health & Fitness (5 answers total) 1 user marked this as a favorite
I've been seeing a therapist for about a year. Last year my co-pays were $20 per session. I knew that the co-pays could increase this year with the advent of the Affordable Care Act, but I did not receive any notification from my insurer and have continued to pay my therapist $20 per visit. Today I got an EOB from my insurer listing all of my visits since the beginning of the year and each visit is broken down like this:
Considered charges: $100
Provider responsibility: $40
Patient Non-Covered: $0
Allowed Amount: $60
You Owe: $40
My question: Why do I owe $40 per visit if my co-pay is $40? It seems like they are saying my co-pay is $60 and I've paid $20 towards that and now owe $40. If my co-pay is $40, wouldn't I only owe an additional $20 per visit?
If it matters, my therapist is in-network and I have $0 deductible for in-network providers.