CARC 2: Coinsurance Amount
After your deductible is met, you still owe a percentage of each claim — this is your coinsurance share.
What this means for your claim
Your plan uses coinsurance (a percentage split, like 80/20) instead of or in addition to fixed copays. The amount shown is your share of an already-discounted allowed amount.
What to do next
- 1
Check your Summary of Benefits to confirm the coinsurance rate for this service type (e.g., specialist, ER, inpatient).
- 2
Verify the allowed amount the coinsurance is calculated against matches your plan's contracted rate.
- 3
If you've already met your out-of-pocket maximum this year, your coinsurance should be $0 — request reprocessing if it's not.
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