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Patient Responsibility Calculator Print

Locate your insurance agreements in order find out what the patient can be billed or use the calculations provided below:

Note: In rare circumstances, when the primary obligated to accept allowed amount is lower than the Medicare allowed amount, this calculator will not determine the accurate patient responsibility.

Agreement with the primary insurance company Agreement with Medicare Patient can be billed
Participating Participating Up to the Medicare Fee Schedule
Non-participating Non-participating Up to the billed amount or limiting charge amount (the smaller of the two amounts)
Participating Non-participating Up to the primary insurer's allowed amount
Non-participating Participating Up to the Medicare Fee Schedule
(You are required to use the Secondary Liability Calculator before using this form.)
Medicare Participating Providers

Medicare Fee Schedule

Primary Insurance Payment

Medicare's Payment

Press To Reset Form

Perform Calculation

Amount That Patient Can Be Billed
Non-participating with both the primary insurer and Medicare

Limiting Charge Amount

Billed Amount

Primary Insurance Payment

Medicare's Payment

Press To Reset Form

Perform Calculation

Amount That Patient Can Be Billed
Non-Participating With Medicare Only

Primary Insurer's Allowed Amount

Primary Insurance Payment

Medicare's Payment

Press To Reset Form

Perform Calculation

Amount That Patient Can Be Billed
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