Coordination of Benefits Calculator accuracy and testing

Formula source

• Estimated patient responsibility = max(0, allowed amount - primary payment - secondary payment) + non-covered amount.

Test cases

Known limitations

• This page documents the checked-in calculator logic and does not certify results for every real-world edge case.
• Use the result as a planning estimate unless the calculator page states a stricter purpose.

Assumptions

• All entered amounts refer to the same claim, service, or claim line.
• Payer-specific COB rules, contractual adjustments, carve-outs, exclusions, and state rules are not inferred.
• This is an insurance workflow estimate, not legal, coverage, billing, or benefits advice.
• No claim details are stored; the calculation runs from the values you enter.

Unit handling

• Allowed Amount accepts values in $.
• Primary Insurance Payment accepts values in $.
• Secondary Insurance Payment accepts values in $.
• Non-covered Amount accepts values in $.
• Estimated Patient Responsibility is displayed as currency.
• Total Insurance Payments is displayed as currency.
• Estimated Covered Percent is displayed as a percentage.
• Possible Overpayment is displayed as currency.

Rounding rules

• Number displays use up to 2 decimal places in the calculator UI.
• Currency outputs are displayed with standard US dollar formatting.
• Percent outputs are displayed with two decimal places.
• Input precision follows configured step values where provided.

Version history

Change log