EOB Calculation Formulae

1. Billed Amount = Allowed Amount + Contractual Adjustment
2. Allowed Amount = Paid Amount + Patient Responsibility
3. Patient Responsibility = Coinsurance + Co-payment + Deductible
4. Paid Amount = Allowed Amount – Patient Responsibility

EOB Calculation:

If Billed amount = $200,

Allowed amount = $170,

Co-pay = $20,

Co-insurance = $34.

    Calculate:

1) Discount &  2) Paid Amount ?

    Discount = Billed amount  – Allowed amount = 

    $200      – $170       = $30

Patient Responsibility = Co-insurance + Co-pay + Deductible = 

        $34 + $20      + $0      = $54

    Paid amount = Allowed amount – Patient Responsibility = 

                 $170     –  $54        = $116