What is the term for the amount that an insurance company states is not the responsibility of the patient for a contracted physician?

The term that refers to the amount an insurance company states is not the responsibility of the patient for a contracted physician is an adjustment. An adjustment typically occurs when the insurance company reduces the billing amount based on the contracted rates agreed upon with the physician or healthcare provider. This reduction signifies that the patient will not need to pay that portion of the bill as it is accounted for by the insurance plan.

In this context, it's vital to distinguish adjustment from other terms. A copay is a fixed amount that a patient is required to pay for a specific service or medication at the time of the appointment. A deductible is the amount a patient must pay out-of-pocket for covered healthcare services before their insurance begins to pay. An exclusion refers to specific services or conditions that are not covered by the insurance policy. Understanding the nuances of these terms helps clarify the financial responsibilities of both patients and insurance providers in the healthcare system.