Work out insurance claim estimate instantly with clear inputs, formula shown and shareable results.
Works out the insurer's payment after the deductible and coinsurance, then caps your share at the remaining out-of-pocket maximum.
Claim settlement
Patient share = min(deductible + coinsurance x (allowed amount - deductible), out-of-pocket maximum remaining); reimbursement = allowed amount - patient share
Educational estimate only. Not a substitute for professional clinical judgement, and must not be used to make treatment or dosing decisions.
The contracted price between insurer and provider, which is usually well below the billed charge.
In most plans yes, but premiums never do.