What is identified as the amount an insurance company may say is not allowed and is not the responsibility of the patient on their account?

The correct answer is identified as an adjustment. This refers to the difference between the billed amount by a healthcare provider and the amount that the insurance company determines is allowable for that service. Adjustments are often made due to factors such as negotiated rates between healthcare providers and insurers, insurance plan limitations, or contractual agreements.

In this case, the adjustment represents the amount that the insurance company does not allow, indicating that it will not be the patient's responsibility to pay this portion. Understanding adjustments is vital in revenue cycle management as it impacts the final billing, collections, and financial planning for both patients and healthcare providers.

Other terms, such as deductible, co-payment, and out-of-pocket maximum, refer to different aspects of patient financial responsibility. A deductible is the amount a patient must pay out-of-pocket before insurance coverage kicks in. A co-payment is a fixed amount that a patient pays for specific services at the time of the service. An out-of-pocket maximum is the total limit a patient would pay in a benefit period, after which the insurance covers 100% of the costs, but none of these terms encompass the notion of amounts not allowed by the insurance company.