Question

1. The patient's health insurance plan has a $750 deductible for hospital visits, and then it covers 100 percent of hospital visit charges. The patient's first hospital visit this year had charges of $612. The patient was subsequently admitted to the hospital a second time this year, and the charges totaled $358. How much will the patient be billed for each visit? How much will the health insurance plan reimburse for each visit?

2 A patient insured under an indemnity plan has an annual deductible for office visits of $100, after which the office plan covers 100 percent of 000 and requires a separate annual deductible for hospital coverage of S after which it covers 100 percent of charges. The patient was seen in the office, a normal office visit charge is $45 and was immediately sent to the

hospital for an emergency appendectomy. The surgery charges totaled

$7,382. How much, if anything does the patient owe? To whom?

3. A patient in a POS plan has a $10 copayment and a 70-30 coinsurance rate on the balance of the charge. The patient is seen for an office visit the total charge for the office visit is $85. What amount is owed by the patient?

4. Holly Hiker is insured by an HMO whose network is exclusive to her home city in Pennsylvania. The HMO expects patients to pay any costs up front when accessing healthcare services out of network; the patient then submits the charges for 80 percent reimbursement except in emergency cases when 100 percent is reimbursed. She had a life threatening injury while on a hiking vacation in Maine. She received treatment at the local trauma center's emergency room that cost $1,732. What amount must Holly pay to the hospital in Maine? What amount will Holly be reimbursed by her HMO?

5. The patient has two insurance policies. Each policy's coinsurance is 80-20. If the patient has charges totaling $845, what amount should the medical insurance specialist expect to be reimbursed from Insurer A? From Insurer B? For what amount should the patient be billed?

6. The patient's insurance plan pays 80 percent of eye examinations for preventive care but does not pay for ophthalmology services related to refractions; the patient is responsible for these charges. The patient is examined by an ophthalmologist and prescribed corrective lenses, The bill is detailed as follows:  $PXL_20210221_030829568~2.jpg$

What amount is covered by the patient's insurance plan? What amount must the patient pay?

7. Sheena's health plan has a $250 deductible for each person or a maximum deductible of $1,000 for a family of more than four people per year. Once the deductible has been met, the plan reimburses on a 90-10 basis. Sheena's son, Shane, frequently sees a healthcare provider for a chronic illness. In fact, he was seen in the office on 1/14, 2/3, 2/24, 3/7, and 3/11 this year; his office visit charges total $375. Sheena's daughter, Sharon, had office visits on 1/28, 2/17, and a minor surgical procedure performed in the doctor's office on 2/18; her charges total $975. Sheena has now received a bill for her children's services through 3/31. What is the total amount due from the health plan? What is the total amount to be paid by Sheena?

Answer 1

One Question Per Post

Patient bill

Visit 1: $612

(Since the bill amount is within the deductible, the entire amount will be paid by the patient)

Visit 2: 358-(750-612) = 220

(The patient pays the balance of charges after the deductible is fully met)

Insurance reimbursement

Visit 1: 0

(Since the bill amount is within the deductible, the entire amount will be paid by the patient)

Visit 2: 358-220 = 138

(Charges Till the amount of deductible is paid by the patient, balance by the company)