Certified Revenue Cycle Representative (CRCR) Practice Exam

What does the term 'out of pocket payment' refer to?

1. The total cost of a medical procedure

2. A type of health insurance plan

3. The portion of total payment for which the patient is responsible

4. A payment made by the insurance company on behalf of the patient

The correct answer is: The portion of total payment for which the patient is responsible

The term 'out of pocket payment' specifically refers to the portion of total medical expenses for which the patient is personally responsible, not covered by insurance. This includes expenses such as deductibles, copayments, and coinsurance that patients pay directly to healthcare providers. It reflects the costs that individuals must pay from their own finances for healthcare services, which can vary based on an insurance plan's coverage and the medical services received. In terms of context, the total cost of a medical procedure encompasses all expenses related to the service, but does not specify the patient's individual responsibility. A type of health insurance plan refers to the structure and benefits of an insurance offering, which may include out-of-pocket limits, but is not what the term refers to directly. Lastly, a payment made by the insurance company on behalf of the patient describes the insurance coverage in action, which contrasts with the concept of out-of-pocket payments where the patient is utilizing their own funds.