The charge that the patient pays directly when receiving service, regardless of coverage, is called the

• A. Encounter
• B. Co-payment
• C. Procedure number
• D. Explanation of benefits

Answer: (B)

A fixed amount the patient pays at the time of service is called a co-payment. Co-pays are set by the patient’s insurance plan and are collected upfront regardless of the total charge or whether the service is fully covered. This is different from a deductible, which is the amount the patient must pay out of pocket before the insurer starts paying, and from coinsurance, which is the percentage of costs the patient pays after meeting the deductible. The other terms aren’t about patient payment at the point of service: an encounter is the visit itself, a procedure number is the billing code for the service, and an Explanation of Benefits is the insurer’s statement after processing the claim.