The patient’s share of the cost that is not borne by the insurer is called the

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

Answer: (B)

Cost sharing in a health plan often involves the patient paying a portion of the cost. A fixed amount paid at the time of service is called a co-payment. This is the amount the patient hands over when receiving a covered service, with the insurer covering the rest according to the policy. The other terms don’t describe this specific situation: an encounter is just the record of a visit, a procedure number is a billing code, and an Explanation of Benefits is the insurer’s statement detailing what was billed and paid. Co-insurance, by contrast, is a percentage of the allowed amount after any deductible has been met, not a fixed upfront payment.