case 8.3 medical ins Using this fee schedule for three different payers for orth

Question

case 8.3 medical ins Using this fee schedule for three different payers for orthopedic procedures. Complete the questions that follow A patient with BCBS PPO coverage has surgical knee arthroscopy with medial and lateral meniscectomy. The plan has an 80-20 coinsurance, with no copayment for surgical procedures. The annual deductible is met. What will the plan pay, and what amount does the patient owe? A united patient has a high-deductible plan with a $1, 200 deductible for this year that has not been met and 75-25 coinsurance. He has surgical knee arthroscopy with debridement. What will the plan pay, and what amount does the patent owe? Another payer offers the practice a contract based on 115 percent of the Medicare Fee Schedule. What amounts are offered for the codes above?

Explanation / Answer

a> The BCBS plan has a 80 - 20 coverage that is for the procedure the BCBS would pay 80 % of the total bill and the remaining 20% would be owed by the patient.

here the patient underwent the procedure with cond : 29880

the total cost of the the procedure is = $ 1167.23

so the BCBS pays = 80% of 1167.23 = .8*1167.23 = $ 933.784

and th patient pays = 1167.23 - 933.784 = $ 233.446

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