G A patient has a highdeductible consumerdriven health plan

G. A patient has a high-deductible consumer-driven health plan The annual deductible is $2,500, of which $300 has been paid. After a surgical procedure costing $1,890, what does the patient owe? Can any amount be collected from a payer? Why? Click here to enter the answer. H. A patient with a high-deductible consumer-driven health plan has met half of the $1,000 annual deductible before requiring surgery to repair a broken ankle while visiting a neighboring state. The out-of-network physician\'s bill is $4,500 The PPO that takes effect after the deductible has been met is an 80-20 in-network plan and a 60-40 out-of-network plan. How much does the patient owe? How much should the PPO be billed? Click here to enter the answer.

Solution

(G) The patient owes $1890

if the negotiated rate is $1890

Why- Because the patient did not match his deductible balance which is rupees 2500

(H) Since health plan has met half he owed which comes to - 1000/2 =500

Out of network physician, bill =4,500

so. 4,500-500=4000

The plan will pay 60% of 4000 = 4000*0.6 = 2400

After the deductible is met the left amount is 4000 - 2400 = 1600

so which means the patient will pay =500 + 1600 = 2100 ( where 500 is the remaining of deductible)