| Course | HC 306 Healthcare Finance |
|---|---|
| Unit | Unit 2 |
| Paper type | Patient responsibility calculation |
| Length | About 1,000 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | BS in Healthcare Administration |
| Updated | October 2026 |
Free sample paper for HC 306 Unit 2
$445 Billed, $217 Allowed, $109 Owed: A Patient Responsibility Calculation for One Office Visit Under a Marketplace Silver Plan
Student Name
Health Care Administration, Herzing University
HC 306: Healthcare Finance
Instructor Name
January 22, 2026
$445 Billed, $217 Allowed, $109 Owed: A Patient Responsibility Calculation for One Office Visit Under a Marketplace Silver Plan
The Visit
In March, a 52-year-old patient with high cholesterol and a history of asthma visits Bayside Family Medicine, the composite Florida clinic from the previous unit, for a follow-up. The physician performs an established-patient visit of moderate complexity, an in-office breathing test (spirometry), and orders a lipid panel drawn in the clinic's lab. The patient is enrolled in an individual marketplace silver plan.
Charges and Allowed Amounts
The clinic's fee schedule sets a charge for each service. The plan's contract with the clinic sets an allowed amount, the most the plan and patient together will pay.
| Service | Code | Billed charge | Allowed amount | Contractual write-off |
|---|---|---|---|---|
| Office visit, established patient, moderate complexity | 99214 | $260 | $148 | $112 |
| Spirometry | 94010 | $95 | $41 | $54 |
| Lipid panel | 80061 | $70 | $22 | $48 |
| Blood draw | 36415 | $20 | $6 | $14 |
| Total | $445 | $217 | $228 |
The Distance Between Billed and Allowed
Before any patient share is calculated, $228 of the $445 bill disappears. That amount is a contractual write-off: the clinic agreed, in its contract with the plan, to accept $217 for these services, and it may not bill the patient for the difference. The billed charge works like a sticker price that insured patients never actually pay; the allowed amount is the real price for this patient. Confusion about this step is the most common reason patients call the billing office, because the statement shows a $445 charge and a much smaller amount due. Every calculation below starts from the $217 allowed amount.
The Plan's Benefit Design
Annual deductible, $5,000, of which the patient has met $1,800 this year, leaving $3,200. Coinsurance after the deductible, 30%. Primary care office visits: $40 copayment, not subject to the deductible. Diagnostic tests and lab work: subject to the deductible, then coinsurance. Annual out-of-pocket maximum, $8,500, of which the patient has paid $2,100 so far, including copayments. Preventive services required to be covered without cost sharing, such as a cholesterol screening test for an eligible adult, are covered in full (45 C.F.R. § 147.130). This lipid panel is not a screening test; it monitors a known condition, so it is diagnostic and subject to the deductible.
The Calculation, in the Order the Plan Applies It
Step 1, copayment on the office visit. The visit's allowed amount is $148. The benefit uses a $40 copayment, which is not subject to the deductible. Patient pays $40; plan pays $148 − $40 = $108.
Step 2, deductible on the tests. Spirometry $41, lipid panel $22 and blood draw $6 total $69 allowed. The patient has $3,200 of deductible remaining, which exceeds $69, so the whole $69 applies to the deductible. Patient pays $69; plan pays $0. Remaining deductible after this visit: $3,200 − $69 = $3,131.
Step 3, coinsurance. Coinsurance applies only after the deductible is met. Nothing is left after Step 2, so coinsurance is $0 for this visit.
Step 4, out-of-pocket ceiling. The patient's out-of-pocket spending so far is $2,100. Adding this visit's $109 brings it to $2,209, well below the $8,500 maximum, so the ceiling does not reduce the amount owed. Federal law caps each plan's annual cost sharing for covered in-network essential benefits under 42 U.S.C. § 18022; once the patient reaches the plan's maximum, the plan pays the whole allowed amount for covered services for the rest of the plan year.
Result: patient responsibility $40 + $69 = $109. Plan payment $108. Check: $109 + $108 = $217, the allowed amount.
The Same Visit Later in the Year
The answer changes with the calendar, which is why a clinic cannot quote one price for a visit. If the same visit happened in October, after the patient had met the deductible, the office visit copayment would still be $40, but the $69 of tests would be subject to 30% coinsurance: 0.30 × $69 = $20.70. Patient responsibility would be $40 + $20.70 = $60.70, and the plan would pay $217 − $60.70 = $156.30. If the patient had already reached the $8,500 out-of-pocket maximum, the patient would owe nothing, and the plan would pay the full $217.
The Same Visit Under Medicare
A Medicare patient receiving the same services shows how much the answer depends on the payer. Under the clinic's Medicare allowed amounts for its locality, the visit is allowed $128, spirometry $36, the lipid panel $13 and the blood draw $3, a total of $180. Assume the patient has already met the annual Part B deductible. The visit and the spirometry are subject to 20% coinsurance: 0.20 × ($128 + $36) = $32.80. The lipid panel and the blood draw are paid under Medicare's clinical laboratory fee schedule, which carries no deductible or coinsurance for the patient, so they add nothing. Patient responsibility is $32.80, and Medicare pays $180 − $32.80 = $147.20. If the patient holds a supplemental policy that covers Part B coinsurance, the patient owes nothing and the supplemental insurer pays the $32.80.
The comparison makes two points for the office manager. First, the same services produce a patient share of $109 under one plan and $32.80 or nothing under another, so estimates must be built from each patient's coverage, not from a clinic-wide average. Second, the clinic receives $217 in total from the marketplace plan and patient combined, but $180 from Medicare and the patient, which is why payer mix matters as much as volume.
What the Front Desk Should Do
At check-in, the clinic can collect the $40 copayment with confidence, because the benefit design fixes it. It should not try to collect the $69 at the visit unless the eligibility check shows the remaining deductible, since the plan applies the deductible only when it processes the claim. Instead, the staff member should tell the patient that the tests will likely count toward the deductible and give an estimate of about $69. When the plan's explanation of benefits arrives, the clinic bills the patient for the amount the plan assigned to the deductible. This approach, estimating in advance and billing the confirmed amount, fits the patient-responsibility steps in the course text (Pink & Song, 2020) and prevents the most common complaint: a bill the patient never expected.
References
Coverage of preventive health services, 45 C.F.R. § 147.130 (2025).
Pink, G. H., & Song, P. H. (2020). Gapenski's fundamentals of healthcare finance (3rd ed.). Health Administration Press.
Requirements relating to essential health benefits, 42 U.S.C. § 18022 (2025).
What the HC 306 Unit 2 instructions ask for
Unit 2 asks you to calculate a patient's financial responsibility for a health care visit. Expect to describe the visit and services, show charges and allowed amounts, explain the difference, set out the benefit design, calculate in the order the plan applies its rules, show how the answer changes and say what the front desk should do. Students often ask why the bill and the patient's share differ so much. The allowed amount, not the charge, is the starting point, and the contractual write-off is never billed to the patient. Apply copayments, deductibles and coinsurance in the plan's order. Note services the plan covers without cost sharing. Show how timing and payer change the result.
Inside the HC 306 Unit 2 example
First comes a short account of who the patient is and which services the physician performed. A table lists each service's charge and allowed amount. The write-off section explains why $228 of the bill disappears under the clinic's contract. The benefit section lists deductible, amount met, coinsurance and the office visit copayment. The calculation applies the copayment to the visit first, then the deductible to the remaining services, showing the plan's and patient's shares at each step. The October section recalculates after the deductible is met. The Medicare section uses Medicare allowed amounts and 20% coinsurance. The front desk section advises collecting the $40 copayment at check-in and billing the rest after the claim is processed.
HC 306 Unit 2 rubric: what full points look like
Herzing's rubric for a patient responsibility calculation typically covers the visit, charges and allowed amounts, the write-off, benefit design, the step-by-step calculation, variations and front desk guidance. A correct calculation in the order the plan applies its rules weighs most heavily, since an error at one step carries through to every later figure. Charge points reward a table by service. Write-off credit goes to a clear explanation of contractual adjustments. Benefit criteria look for deductible, coinsurance and copayment terms. Variation points reward recalculations by date and payer. Guidance should be practical for check-in. Gapenski's healthcare finance text, the essential health benefits statute and the preventive services rule support the calculation.
Common HC 306 Unit 2 mistakes, and how to avoid them
Responsibility calculations in HC 306 Unit 2 commonly lose points by starting from the charge instead of the allowed amount. Another frequent problem is applying the deductible to a service that carries a copayment. Students often bill the contractual write-off to the patient. Steps are combined, hiding errors. Preventive services that carry no cost sharing are charged anyway. The answer is given for one date only. Medicare rules are confused with commercial plans. Front desk guidance is missing. Finally, show each step in the plan's order, because graders reward a calculation a billing specialist could check line by line and explain to the patient over the phone.
Get a HC 306 Unit 2 example written to your instructions
Send the Unit 2 instructions and the rubric from your HC 306 classroom, along with any benefit terms your section wants applied. We write a custom example that separates the write-off from the patient share, runs the arithmetic one line at a time and states the final balance plainly, back in 24 to 48 hours. The first custom sample is free.
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HC 306 Unit 2 questions, answered
Where do I get plan terms to work from?
Published benefit summaries are the usual source, and most insurers post sample documents carrying a deductible, a coinsurance percentage and an annual ceiling, which is everything the calculation needs. If your instructions supply figures of their own, use theirs exactly and say on the page that you did, because whoever marks it will be checking your arithmetic against the numbers they handed you.
Does the example need a real claim document?
No, and a genuine claim form belongs nowhere near a submitted file, since it carries identifying detail about somebody. Describe the visit yourself, present the charge and the allowed amount as given figures, and label them illustrative. What has to be real is the order you apply the benefit terms in and the way each one is defined, which is what a rubric is reading for.
What if my figures do not reconcile?
Then something above the failing line is wrong, and the allowed amount is the usual culprit. Add the plan payment to the patient share and check the total against the allowed amount rather than the charge; those two should meet exactly. Showing that check on the page is worth the three lines it takes, because reconciliation is the skill the unit is quietly testing.
Where can I find a free HC 306 Unit 2 sample paper?
Read the complete HC 306 Unit 2 patient responsibility calculation here at no charge, one office visit under a silver plan from $445 billed to $109 owed. Ask for a custom calculation for another plan.
How do you calculate what a patient owes after insurance?
Start from the allowed amount, apply the copayment where the plan uses one, then the remaining deductible, then coinsurance on what is left. This sample works through each step for one visit.