In: Finance
Assigned Exercises
Checking your understanding
1. Calculation of insurance mathematics
◦ The patient's insurance policy states: Annual deductible: $
300.00; Coinsurance: 70-30
◦ This year, the patient made payments totaling $ 533 to all
providers. Today the patient has a visit to the office (fee: $
80).
◦ Amount to be charged to the patient ____________
Charges
2. The patient is a member of a plan with a 15% discount from the
usual provider fees and a $ 10 copayment. Today's charges are $
480.
◦ Amount to be billed to the plan ___________
◦ Amount to be charged to the patient ____________
3. The patient is a member of a plan that has a 20% discount to
the provider and a 15% copayment. Today's charges are $ 210.
◦ Amount to be billed to the plan _________
◦ Amount to be charged to the patient ___________
Answer 1:
Given:
Annual deductible: $ 300.00;
Coinsurance: 70-30
The patient made payments totaling $ 533 to all providers.
Cost of today’s visit = $80
Hence:
Amount to be charged to the patient = $300 + (533 - 300) * 30% + 80 * 30% = $393.90
Insurance co pays = (533-300) * 70% + 80 * 70% = $219.10
As such:
Amount to be charged to the patient = $393.90
Insurance co pays = $219.10
Answer 2:
The patient is a member of a plan with a 15% discount from the usual provider fees and a $ 10 copayment.
Today's charges are $ 480.
As such:
Amount to be billed to the plan = $480 - 480 * 15% - $10 =
$398
Amount to be charged to the patient = $10
Hence:
Amount to be billed to the plan = $398
Amount to be charged to the patient = $10
Answer 3:
The patient is a member of a plan that has a 20% discount to the provider and a 15% copayment.
Today's charges are $ 210.
As such:
Amount to be billed to the plan = $210 - 210 * 20% - 15% * ($210
- 210 * 20%) = $142.80
Amount to be charged to the patient = 15% * ($210 - 210 * 20%) =
$25.20
Hence:
Amount to be billed to the plan = $142.80
Amount to be charged to the patient = $25.20