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Published byClaribel Brooks Modified over 9 years ago
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Peace of Mind Insurance can give you financial security and peace of mind, especially in case of unexpected expenses. When do people use insurance?
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Lesson Objective Calculate the amount the patient pays for health care. Content Vocabulary deductible The amount of money you must pay each year before your insurance company starts paying. co-insurance co-payment co-insurance Requires you to pay either a set amount or a certain percent of medical expenses. co-payment A predetermined flat fee you pay for health care services.
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Brooke Kolodie is single and has a health insurance plan with the benefits shown in Figure 11.1 on page 421 or your textbook. Her recent network health costs include co- payments for 8 physician visits and 9 specialist visits. Example 1
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Following hospital surgery, she made co- payments for 12 physical therapy visits at $85 each and she had co-payments at her local pharmacy for 3 generic drugs and 1 brand name drug. The hospital admission charge was $200, and her hospital bill was $34,560. What amount did she pay? Example 1 (cont.)
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Find the deductible. The deductible is $1000. Example 1 Answer: Step 1
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Find the cost of the co-payments. Physician + Specialists + Physical Therapy +Pharmacy ($20 × 8) + ($30 × 9) + ($85 × 20% x 12) + 3(10)+20 = $160 + $270 + $204 + $50 = $684 Example 1 Answer: Step 2
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Find the co-insurance amount for home health care. (Note: Co-insurance requires the insurance company to pay 80 percent of the costs and the patient pays 20 percent of the costs.) $55 × (75 – 50) × 20% $55 × 25 × 20% = $275 Example 1 Answer: Step 3
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Find the hospital charges. (Note: The patient pays a small percent of the hospital charge, such as 10 percent.) $34,560 × (100% – 90%) + 200 $34,560 × 10% + $200= $3656 Example 1 Answer: Step 4
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Find the amount paid by patient. Deductible + Co-payment + Co-insurance + Hospital Amount Charges $100 + $684 + $3656 = $5340 Example 1 Answer: Step 5
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Refer to Figure 11.1 on page 421 of your textbook. Leonard Smalls Family plan, Non-network Co-payments: 22 physician visits;12 specialist visits; 25 physical therapy visits at $55 each; 1 ER visit; hospital charge of $15,600 Find the deductible, co-payment, co-insurance, hospital charges, and total paid by the patient. Practice 1
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Deductible: $4,500 Co-payment: 22(30) + 12(40) +100 = $1240 Hospital co-insurance: 15600(.3) = $4,680 Co-insurance: 25(55)(.3) = $412.50 Total paid: $10,832.50 Practice 1 Answer
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