Question

Haiquao Wei is insured by an indemnity insurance plan that reimburses on a 75-25 basis. Mrs. Wei is seen in the office for a physical exam: the charges total $340. What is the amount to be billed to the insurance plan? What amount, if any, is due from the patient.

Juanita Berrios has managed care insurance with a $20 copay charge only for in-network providers. Use of an out-of-network provider means Juanita will have a $100 deductible and a 55-45 reimbursement. Juanita visited her in-network PCP on 4/13; the charge was $135. What amount is due from the patient?

Answer 1

(1): Here the insurance company will bear 75% of the cost and the remaining 25% will be borne by Mrs. Wei.

Thus amount billed to the insurance plan = $340*75% = $255

Amount due from the patient = $340*25% = $85

(2): Here the patient visited the in-network provider and so the amount due from patient is $20.This is because this is the copay amount.