Medical Insurance - Math

The patient is enrolled in a capitated HMO with a $10 copayment for primary care physician visits and no coinsurance requirements. After collecting $10 from the patient, what amount can the medical insurance specialist bill the payer for an office visit?

$0

A patient's total surgery charges are $1,278. The patient must pay the annual deductible of $1,000, and the policy states a 80-20 coinsurance. What does the patient owe?

$1056.60 20% of 278=56.60 56.60+1000=1056.60

What is the annual deductible?

$2,500

The patient's coinsurance percentage is stated as 80-20 in the insurance policy. The deductible for the year has been met. If the visit charges are $420, what payment should the medical insurance specialist expect from the payer? What amount will the patient be billed?

$336 ins; $84 patient

The patient has a policy that requires a $20 copayment for an in-network visit due at the time of service. The policy also requires 30 percent coinsurance from the patient. Today's visit charges total $785. After subtracting the copayment collected from the patient, the medical insurance specialist expects a payment of what amount from the payer? What amount will the patient be billed?

$535.50, $229.50 785-20=765 30% of 765 = 229.50 765-229.50=535.50

What is the annual premium?

$5659.92 1,414.98*4=5659.92

The patient's coinsurance percentage is stated as 75-25 in the insurance policy. The deductible for the year has been met. If the visit charges are $1,000, what payment should the medical insurance specialist expect from the payer? What amount will the patient be billed?

$750 ins; $250 patient

The patient's health plan has a $100 annual deductible. At the first visit of the year, the charges are $95. What does the patient owe?

$95

WHat percentage of preferred provider charges does the patient owe after meeting the deductable each year?

0

if the insured insures a $6,000 in-network medical bill after the annual deductible has been paid how much will the health plan pay?

6000

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What type of health plan is described: HMO, PPO, or Indemnity

PPO

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H. A patient with a high-deductible consumer-driven health plan has met half of the $1,000 annual deductible before requiring surgery to repair a broken ankle while visiting a neighboring state. The out-of-network physician's bill is $4,500. The PPO that takes ffect after the deductible has been met is an 80-20 in-network plan and a 60-40 out-of-network plan. How much does the patient owe? How much should the PPO be billed?

The patient owes $2,100, PPO pays $2,400. 4500-500=4000 40% of 4000=1600 1600+500=2100 60% of 4000=2400

A patient has a high-deductible consumer-driven health plan. The annual deductible is $2,500, of which $300 has been paid. After a surgical procedure costing $1,890, what does the patient owe? Can any amount be collected from a payer? Why?

The patient owes the total amount of the surgical procedure since that amount is less than his deductible and he cannot collect any amount from the payer. The Deductible is the amount that a patient has to pay out of his pocket before the start of the insurance plan. So, the lower the deductible amount, the higher monthly payments. The deductible in this case for the patient is 2500$, which means the patient will be responsible for all the medical costs until he has met his deductible amount of 2500$. Here, since the cost of surgery is 1890$ which is less than the deductible of 2500$ there is nothing that the patient can get from the co-payer.

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