A patient cost estimate is the dollar amount a patient is expected to owe for a specific service, calculated before the visit from their verified benefits and the provider's fee schedule or contracted rate. It accounts for the remaining deductible, copay or coinsurance, out-of-pocket maximum and network status for the exact procedure, provider and place of service.
The estimate is the end product of benefits verification. Without CPT-level benefits it can only be a guess at plan level; without the fee schedule it is a set of percentages with nothing to apply them to. Done well, it is the number the front desk collects and the number the patient sees on a financial responsibility sheet before care.
