ASSIGNMENT NO. 1- BENEFIT GRID (Patient Responsibility)

For this homework, you need to calculate the actual amount that the patient is responsible for each scenario. Please use this weeks powerpoint presentations, video and class textbook (Chapter 2) as reference materials.

	PPO Plan	POS Plan	HMO Plan
PCP co-pay	$25	$20	$15
Specialist co-pay	$40	$30	$20
Emergency room co-pay	$150	$100	$50
Inpatient hospitalization	$300 per day	$200 per day	$300 for entire visit
Out-of-network benefit level	80 / 20	70 / 30	None

The charge for a physicians office visit is $200.00

Scenario: PPO POS HMO

1) Dr Z is an-network PCP $ __________ $ __________ $ __________

2) Dr Y is an out-of-network PCP $ __________ $ __________ $ __________

(or no referral)

3) Dr M is an in-network surgeon $ __________ $ __________ $ __________

4) Dr N is an out-of-network Cardiologist $ __________ $ __________ $ __________

(or no referral)

Inpatient hospital charge is $5,000.00 per day

ER Visits are $2,000.00

5) 3 day inpatient stay, in-network $ __________ $ __________ $ __________

6) 3 day inpatient stay, out-of-network $ __________ $ __________ $ __________

(or no referral)

7) ER visit, in-network $ __________ $ __________ $ __________

8) ER visit, out-of-network $ __________ $ __________ $ __________

(or no referral)