Question

Scenario: Mr tiny was seen by Dr. Kurt, Aetna was billed out for the services, we accept assignment. Mr. Tiny has a counsurance of 90/10; assume there is no deductible at this point or copayment. Aetna responded as follows:

Office visit Charges:190.00 Allowed: 135.00

X-ray Charges: 35.00 Allowed: 18.75

Inj. morphine Charges: 50.00 Allowed: 25.00

How much would you expect Aetna to pay for his services?

Note: round it to the whole number.

Answer 1

An health care plan is designed to provide a financial support to the policy holder to meet or afford the high health care cost.The policy holder has to pay a fixed amount of premium to the insurance company like weekly basis,monthly basis or even yearly basis

There are some terms or rules in an health care plan such as co-insurance,deductible and co-pay.These three represents that the portion of the medical bill that the policy holder has to pay that is out-of-pocket expenses

Co-insurance is a percentage of a medical bill that the patient has to pay out-of-pocket.Here in this case Mr.Tiny has a co-insurance of 90/10,that means insurance company will cover 90% of the medical bill and he has to pay 10%

Deductible is also an out-of-pocket expense that the patient has to pay depending upon the insurance plan.Mr.Tiny has no deductible or out-of-pocket as deductible

Copayment or copay is a fixed amount of money the patient has to pay each time when need to use the insurance plan (fixed amount per visit).Mr has no copayment or out of pocket as copay

*Co-insurance is 90/10

Services	Charges/cost
Office visit	135.00
X-ray	18.75
Inj.Morphine	25.00

Total

178.75

The total bill for Mr.Tiny is 178.75,out of that insurance will cover 90% of the total bill,ie,amount of 161

As a co-insurance or out-ofc-pocket he ha to pay 10% of 178.75

ie,

=17.8 and round it to the whole number,ie,18

Mr.Tiny has to pay an amount of 18