Question

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

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