Question

Stephanie was injured in a car accident was rushed to the emergency room. She received stitches for a facial wound and treatment for a broken finger. Under Stephanie's PPO plan, emergency room care at a network hospital is 80 percent covered after the member has met a $300 annual deductible. Assume that Stephanie went to a hospital within her PPO network. Her total emergency room bill was $850. What amount did Stephanie have to pay? What amount did the PPO cover?

Answer 1

Answer:

60/40

Explanation:

Answer 2

Answer:

Hence,

the amount paid by the Stephanie = $410

The amount covered by PPO = $440

Explanation:

Given:

Percent covered by the insurance = 80%

Annual deductible = $300

Total emergency room bill = $850

Now,

The Coinsurance expenses = Total expenses − Annual deductible

or

The Coinsurance expenses = $850 - $300 = $550

The amount covered by PPO

= Percent covered × Coinsurance expenses

= 0.80 × $550 = $440

Therefore,

the amount paid by the Stephanie

= Annual deductible + (Coinsurance expenses - amount covered by PPO)

= $300 + $550 - $440 = $410

Hence,

the amount paid by the Stephanie = $410

The amount covered by PPO = $440