Question

A patient with a high-deductible consumer-driven health plan has met half of the $1,000 annual deductible before requiring surgery to repair a broken ankle while visiting a neighboring state. The out-of-network physician's bill is $4,500. The PPO that takes ffect after the deductible has been met is an 80-20 in-network plan and a 60-40 out-of-network plan. How much does the patient owe? How much should the PPO be billed?

Answer 1

Answer:

a. patient pays 2,100

b. $2,400

Explanation:

A patient with a high-deductible consumer-driven health plan has met half of the $1,000 annual deductible before requiring surgery to repair a broken ankle while visiting a neighboring state. The out-of-network physician's bill is $4,500. The PPO that takes ffect after the deductible has been met is an 80-20 in-network plan and a 60-40 out-of-network plan. How much does the patient owe? How much should the PPO be billed?

if the patient has payed half of the annual deductible $1000

which is $500

Subtract $500 FROM THE pHYSICIAN'S BILL

. 4,500-500=$4000

The plan will pay 60% out of network amount of 4000 which is 2,400. (4,000 x 60%=2,400)

40% out of network will be payed by the patient

40%*4000= 1600

the patient will pay 500 (remainder of deductible) plus 1,600 which is the 40% of the bill after deductible is meet. So, patient pays 2,100 of the bill.