Question

tephanie belongs to a PPO that has a $1,000 deductible. The deductible applies only if Stephanie meets with doctors outside her network. There is no co-payment. Stephanie incurred a bill of $2,000 when she met with an out-of-network specialist for a thyroid problem. She owes $1,400 out of pocket for the bill. If the PPO pays $600 after Stephanie has paid her deductible, what is the co-insurance clause of the PPO that Stephanie belongs to? 50/50 60/40 70/30 80/20

Answer 1

60/40
2000 bill - 1000 out of network =1000
40% 1000 is 400 insurance paid 60%=600

Answer 2

Answer

Stephanie belongs to 60/40 co-insurance clause of the PPO

Explanation

Cost sharing occurs when an individual and the health insurance company pay for the health care costs. Here, deductibles, coinsurance and copays all occur. A deductible amount is normally paid by a person before his health insurance starts to pay. In this case;

Bill incurred=$2000

Deductible=$1000

Remaining amount=$2000-$1000=$1000

40% ×1000=400 insurance paid

60% =600