Problem #7 (6 points) A patient has a high deductible plan with a deductible of

Question

Problem #7 (6 points) A patient has a high deductible plan with a deductible of $2,500 and 30% coinsurance after the deductible is met. There is a maximum out of pocket limit of $7,000. The patient has met $1,000 of the deductible. The patent uses in network facilities and has the following expenses All are billed at reasonable and customary fees. How much will the patient have to pay for the followin services Initial Office Visit: $150 Prescription: $100 XRays: $300 Lab Tests: $400 First Follow-up Office Visit: $100 MRI: $1200 Second Follow-up Visit:$100 Specialist Consultation $300 Second Surgical Opinion: $300 Surgical Procedure: $4,000 Prescriptions: $50 Amount Paid

Explanation / Answer

Total bill amount =$7000

Deductible which is to be paid by the patient=$2500 but $1000 has already been paid , so deductible=$1500

Balance amount= $7000-$1500= $4500

Coinsurance to be paid by the patient= 4500*30%=$1350.

Amount paid by the patient= $1500+$1350=$2850

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