OIC - Applying Concepts Ch 3 #3
3. Mike Moroni is covered by a member health plan with a 20 percent discount from the provider's ual fear d a 520.00 copay. The charges are $365.50. What amount will the HMO pay? What does the patient owe?
Homework Answers
Outpatient Insurance Coding - Applying Concepts Ch 3
1. The patient is insured by a PPO with 100 percent coverage after a copay of $15. The patient was seen in the office for a checkup, and the total charges were $115. What amount must the patient pay? When? What amount must the insurance plan pay? When?2 Afaf Darcy is insured by an HMO with a $10 copay and out-of-network coinsurance on charge balances of 90-10. She needed ysical therapy after her knee replacement. Her HMO pays for eighteen...
Case Study 3.4 Calculating Insurance Math Worksheet Name: Click here to enter your name. INSTRUCTIONS: Calculate...
Case Study 3.4 Calculating Insurance Math Worksheet Name: Click here to enter your name. INSTRUCTIONS: Calculate the insurance in each of the following situations. Upload your completed worksheet to the 3.4 Case Study dropbox. A. A patient's insurance policy states: Annual deductible: $300.00 Coinsurance: 70-30 This year the patient has made payments totaling $533 to all providers. Today the patient has an office visit (fee: S80). The patient presents a credit card for payment of today's bill What is the...
OIC - Applying Concepts Ch 2 #6
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:What amount is covered by the patient's insurance plan? What amount must the patient pay?
Outpatient Insurance Coding - Applying Concepts Ch 1
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...
OIC - Applying Concepts Ch 2 #4
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....
OIC - Applying Concepts Ch 3 #2
2. Afaf Darcy is insured by an HMO with a $10 copay and out-of-network coinsurance on charge balances of 90-10. She needed ysical therapy after her knee replacement. Her HMO pays for eighteen physical therapy sessions in such cases at a rate of $63.50 per visit. If additional physical therapy is needed, the provider must document the reasons and submit a formal request. The therapist requested additional visits, and Ms. Darcy attended five additional physical therapy sessions. The request was...
OIC - Applying Concepts Ch 2 #2
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 fees and requires a separate annual deductible for hospital coverage of $1,000, 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,...
OIC - Applying Concepts Ch 3 #5
5. Harold and Helen Rubright's coverage is with a consumer-driven PPO with a high deductible of $1,000. The patient must pay a $25 copay for office visits. Previously, Mr. Rubright was seen in the office for a minor surgical procedure with charges totaling $1,000. The PPO was billed to maintain a record of the deductible; Mr. Rubright paid $1,000 on 5/3. These entries are shown on the ledger card/patient statement.On 6/21 Mrs. Rubright was seen for an office visit. Charges...
OIC - Applying Concepts Ch 3 #4
4. Lisa Perez was seen in your office twice last fall. Her deductible has been met and her coinsurance is 85-15. In October, she was seen for influenza vaccination, and her insurance company was billed $13.00 for the vaccine and $9.00 for the administration of the vaccine. Lisa's schedule of benefits for her indemnity insurance plan lists the influenza administration as being a covered service, but it does not include the actual vaccine. In December, Lisa had an office visit...
OIC - Applying Concepts Ch 2 #7
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...
Case Study 3.4 Calculating Insurance Math Worksheet Name: Click here to enter your name. INSTRUCTIONS: Calculate the insurance in each of the following situations. Upload your completed worksheet to the 3.4 Case Study dropbox. A. A patient's insurance policy states: Annual deductible: $300.00 Coinsurance: 70-30 This year the patient has made payments totaling $533 to all providers. Today the patient has an office visit (fee: S80). The patient presents a credit card for payment of today's bill What is the...
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