Figure 4 White, Jane 14.40 (80%) Codes and Remarks CI Coinsurance CP Copayment D

Question

Figure 4

White, Jane

14.40 (80%)

Codes and Remarks

CI Coinsurance

CP Copayment

DD Deductible

Had the patient (subscriber) met the deductible prior to the first service included on this document (using Figure 4)?

Cannot be determined

Per Figure 4, after the payment of the third-party payer, how much will the patient have to pay (for all three of these services together)? You may assume this in an in-network provider.                                   

d $344.00

Which type of prescription drug is likely to be the least costly for health plan members using a health plan with a tiered drug benefit (using Figure 4)?

Patient/Service Service Date(s) (A) Total Charge Allowed Amount (B) Not Payable by Plan Plan Paid Amount

White, Jane

Office Visit 02/17/200* 65.00 56.00 10.00 CP 46.00 (100%) X-Ray 02/17/200* 350.00 268.00 250.00 DD
3.60 CI

14.40 (80%)

Lab 02/17/200* 35.00 20.00 15.00 CP 5.00 (100%) Totals

Explanation / Answer

1. Had the patient (subscriber) met the deductible prior to the first service included on this document (using Figure 4)?

Ans. (a) Yes, as evidenced by the plans $250 payment for the deductibles.

2. Per Figure 4, after the payment of the third-party payer, how much will the patient have to pay (for all three of these services together)? You may assume this in an in-network provider.

Ans. (a) $65.40

3. Which type of prescription drug is likely to be the least costly for health plan members using a health plan with a tiered drug benefit (using Figure 4)?

Ans. (a) Generic medication

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