Case Study 3.4 Calculating Insurance Math Worksheet Name: Click here to enter your name. INSTRUCTIONS: Calculate...

Question

Question

Answer 1

✔ Recommended Answer

Answer #1

A:
	Patient annual deductible amount	300
	Since Patient has made payment till date $533, so it is implied that $300 deductible amount is already deducted
	So 2nd clause remain that is Coinsurance 70:30 , means 30% of the claim to be paid be patient

	So total payable	80
	Less: 70% to be paid by insurance company	56
	Net 30% to be paid by patient	24

B.
	There is usual discount to the member patient
	Normal Days Charges	480
	Discount on the Charges=480*15%	72
	Net Charges payable	408

	Patient will Copay (Copay- a small amount at the time of service)	$10
	Remaining amount will be paid by HMO(408-10)	$398


C.
	Normal Days Charges	210.00
	Discount on the Charges=210*20%	42.00
	Net Charges payable	168.00

	Patient will Copay (15%*168)	25.20
	Remaining amount will be paid by HMO(168-25.2)	142.80

Answer 2

Similar Homework Help Questions

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?
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...
Ch 16 Case Studies #8

As with a Medicare RA, when a commercial RA is received, before posting payments and preparing secondary claims that may be required you must carefully review it. When analyzing an RA from a commercial carrier, you must be familiar with the guidelines of that carrier’s particular plan. The type of services covered and the percentage of the coverage will vary, depending on whether the plan is a fee-for-service plan, a managed care plan, a consumer-driven health plan, or some other...

In your judgement, and given only the facts described in this case, should the management of...

In your judgement, and given only the facts described in this case, should the management of Massey energy Company be held morally responsible for the deaths of the 29 miners? Explain in detail. Suppose that nothing more is learned about the explosion other than what is described in this case. Do you think Don Blankership should be held morally responsible for the deaths of the 29 miners? Explain in detail. Given only the facts described in this case, should the...