Question

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 and had blood drawn to be sent to an outside lab; both these services are included in the schedule of benefits.

The ledger card or patient statement shows the dates and charges for services; you need to calculate each amount paid by the insurance plan and enter it on the ledger card or patient statement. Remember to keep a running balance.

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Answer 1

In the coinsurance system, the medical bill is split among the user and provider. In this case, 85-15 is a splitting percentage which means, 85% of the medical bill is provided by the insurance company, and the user will pay 15%.

1.influenze virus vaccine- charge 13 dollar

85% of 13= (85x13)/100 = 1105/100 =11.05

Balance= charge -payment = 13-11.05= 1.95

2.administration of influenza- charge 9 dollar

Payment is 85% of 9= (85x9 )/100 = 765/100=7.65

Balance=charge-payment= 9-7.65=1.35

Plan payment= 85% of 13+85%of 9 =11.05+7.65= 18.7

3 OV Charge =65

Payment is 85%of 65= (85x65 )/100=5525/100=55.25

Balance=charge-payment=65-55.25=9.75

4.drawing blood fee =charge =5

Payment= 85%of 5= ( 85x5)/100= 425/100=4.25

Balance=charge-payment= 5-4.25= 0.75

Plan payment for ov is 55.25

And venipuncture is 4.25; the rest of the payment will be bear by the user.