Question

Evaluating Walter's Health Care Coverage

Walter Burton was a self-employed window washer earning approximately $700 per week. One day, while cleaning windows on the eighth floor of the Commercial Bank Building, he tripped and fell from the scaffolding to the pavement below. He sustained severe multiple injuries but miraculously survived the accident. He was immediately rushed to the local hospital for surgery. He remained there for 58 days of treatment, after which he was allowed to go home for further recuperation. During his hospital stay, he incurred the following expenses: surgeon, $2,300; physician, $900; hospital bill for room and board, $250 per day; nursing services, $1,200; anesthetics, $600; wheelchair rental, $100; ambulance, $150; and drugs, $350. Walter has a major medical policy that has a $3,500 deductible clause, an 80 percent co-insurance clause, internal limits of $170 per day on hospital room and board, and $1,600 as a maximum surgical fee. The policy provides no disability income benefits.

1. Explain the policy provisions as they relate to deductibles, co-insurance, and internal limits.
2. How much should Walter recover from the insurance company?
   $  
   How much must he pay out of his own pocket?
   $  
3. Would any other policies have offered Walter additional protection? What about his inability to work while recovering from his injury?
4. Based on the information presented, how would you assess Walter's health care insurance coverage?
   
   
   Explain.

Answer 1

1. find below the deductible 3,500$ and co-insurance 80% and internal limits for 170$ per day stay.

		Actual Spending		Recoverable
days	58	250	14500	170	9860
surgery	1	2300	2300	1600	1600
physician	1	900	900	80%	720
nursing service	1	1200	1200	80%	960
anesthetics	1	600	600	80%	480
wheel chair	1	100	100	80%	80
ambulance	1	150	150	80%	120
drugs	1	350	350	80%	280
				3500	3500
			20,100		17,600
	Total BILL		20,100
	Paid by Insurance		17,600
	Paid by own pocket		2,500

2. Walter recover from insurance company $17,600

he pays from his pocket $2,500

3. definitely other policy should provide you additional protection, like full medical claim and insurance for disability during work or accident.

4. Walter's health insurance is pretty much average , doesn't cares much about the people who applying, can be much better.