VividPrice was built to simplify the financial side of healthcare—giving your team and your patients clear, accurate estimates before treatment begins. If you’ve ever wondered how costs are calculated or what might cause them to change, this section will walk you through the most important pieces.
You’ll learn how we factor in insurance benefits, contracted rates, deductibles, coinsurance, and even copay assistance—all so you can confidently discuss patient costs up front.
Use the topics below to explore specific questions, like:
How is patient responsibility calculated?
What happens when a patient meets their deductible?
How do copay cards or secondary insurance impact estimates?
Each section gives you a quick explanation of what to expect, how VividPrice handles it behind the scenes, and how your team can use it to improve clarity and build trust.
Let’s dive in →
How are patient responsibilities calculated for infusion treatments?
Patient financial responsibility is calculated based on the patient’s insurance plan and the contracted rates between the payer and your facility.
This includes:
Deductible: The amount the patient must pay out-of-pocket before their insurance begins to cover costs.
Coinsurance: Once the deductible is met, patients may be responsible for a percentage of the allowed amount (e.g., 20%), while insurance covers the remainder.
Out-of-Pocket Maximum: After reaching this limit, the patient typically owes nothing for covered services for the rest of their plan year.
Insurance Contract Rates: All calculations are based on your facility’s contracted rates with the insurance—not the full list price or billed charge.
Do patient costs change over time?
Yes, patient cost estimates may vary slightly due to:
Medicare Pricing Updates: Medicare revises its allowable rates quarterly, which may affect estimates for Medicare beneficiaries.
Insurance Plan Changes: If a patient changes plans or experiences updates to their benefits (e.g., deductible resets), their estimated costs will reflect those changes. Otherwise, estimates generally remain stable
What happens when a patient meets their deductible or out-of-pocket maximum?
After Meeting the Deductible: The patient transitions from paying full cost to paying coinsurance or a copay.
After Meeting the Out-of-Pocket Maximum: No further patient responsibility is expected for covered services within that plan year.
How are administration fees calculated?
Plan-Specific Contracts: Administration fees are driven by the payer’s fee schedule and your facility’s contract with that plan.
Cost-Sharing Requirements: If the patient’s plan includes coinsurance or a fixed copay for the administration portion, this will be reflected in their estimate accordingly.
How is an estimate calculated when a treatment will meet the patient’s deductible and coinsurance will then apply?
When a treatment is expected to meet the patient’s remaining deductible:
Deductible Portion: The estimate first includes the remaining amount the patient must pay to reach their deductible.
Coinsurance Portion: Once the deductible is met, the remainder of the treatment cost is calculated using the patient’s coinsurance rate. For example, if the remaining treatment cost is $1,000 and the coinsurance is 20%, the patient would owe $200 for that portion.
The final estimate adds both parts together to reflect the total patient responsibility for that visit.
How do supplemental insurance, copay cards, and foundations help reduce patient costs?
Supplemental Insurance: Patients with secondary coverage (such as a Medicare Supplement) may have reduced or no out-of-pocket responsibility after their primary insurance is billed.
Copay Assistance Cards: For commercially insured patients, manufacturer copay cards may significantly reduce out-of-pocket costs. These require enrollment and are specific to each drug.
Foundation Grants: For Medicare or underinsured patients, foundations may offer need-based financial assistance. Our team monitors availability and can assist in enrollment when funding is open.