Copay, Deductible and Co-insurance

Insurance billing calculations include several financial components that determine how the bill amount is split between the patient and the insurance provider.

The system supports three primary financial responsibility components:

Copay
Deductible
Co-insurance

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Copay

A copay is a fixed amount that the patient must pay for a specific test or service.

Copay values are configured within the insurance price list and automatically applied when tests are added to a bill.

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Deductible

A deductible represents the portion of the test price that the patient must pay before insurance coverage is applied.

This value is deducted from the total test price before calculating the insurance-covered amount.

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Example Calculation

Test Price: 900
Copay: 20
Deductible: 30

Patient Payable Amount:

20 + 30 = 50

Insurance Payable Amount:

900 − 50 = 850

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Global Billing Inputs

Apart from test-level configurations, the billing modal allows defining global values for the entire bill.

Supported global inputs:

• Global Copay
• Global Deductible
• Global Co-insurance

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Global Co-insurance

Global co-insurance allows defining a percentage-based copay across the entire bill.

Example:

Test Price: 120
Deductible: 20
Co-insurance: 25%

Base amount = 120 − 20 = 100
Copay = 25% of 100 = 25

Total Patient Payable = 45