In the above situation, this patient has both a private payer and a payer assist pay card (PAPC). In all situations the PAPC is the last payer. There are a few issue to consider when processing PAPC and can become confusing.
Note 1 – there is a large differece with the markup and cost of medication from the first payer. This is normal as the first payer is only paying the price and mark-up of the generic alternative.
Note 2 – This patient’s private pay does not pay anything toward the dispensing fee and the patient is responsible for the $9.99 dispensing fee. (while our dispensing fee to the companies is $10.99 we charge patients that pay cash $9.99). Note the Deductible is $8.42 from the first payer, the patient is responsible for this too.
Note 3 – In this situation, the correct price cannot be obtained by checking the waive box. It must be calculated by adding the Deductible + Dispensing Fee not covered by the private payer ($8.42+$9.99=$18.41).