5. Jane Sanders is covered by an employer-sponsored group PPO plan that includes in-network benefits of $250.00 deductible, $35.00 office visit copay, 90/10 and out-of-network benefits of $500.00 deductible, 75/25. Dr. Smith, a nonPAR provider, treated Jane recently resulting in $612.00 in charges: (office visit charge: $236.00 / allowed: $211.00, surgical procedure charge: $376.00 / allowed: $335.00). What dollar amount is the insurance carrier expected to reimburse? What dollar amount is the patient responsible for?

Insurance:

Patient:

Write-off: