Basic Insurance Calculations. (6 points each) Deductible $2,500.00 Coinsurance 70/30% Physician Office Visit (non-specialist) - Covers all covered $25.00 services" performed in the office Specialist Office Visit - Covers all "covered services" $35.00 performed in the office Emergency Department (waived if hospitalized as inpatient) $175.00 Urgent Treatment Center $50.00 Inpatient Hospitalizations - Applies separately to all claims After deductible, coinsurance associated with the inpatient hospitalization Outpatient Surgery - Applies separately to all claims After deductible, coinsurance associated with the inpatient hospitalization Physical & Occupational Therapy Visit $25.00 Out-of-Pocket Maximum $5,750.00 1. Brady was having abdominal pain and running a fever so he went to his family physician for an examination. The allowable was $104.56 for the visit. Total Insurance Consideration Amount Running Balance II Insurance Allowance (Total) Deductible (Patient) Coinsurance or Copay (Patient) Insurance Payment $0.00 2. Billy goes to Move Well PT Clinic for his 4 sessions. The allowable for each visit $143.00. How will the total PT bill be handled? Total Insurance Consideration Amount Running Balance Insurance Allowance (Total) Deductible (Patient) Coinsurance or Copay (Patient) Insurance Payment $0.00 3. Jarrett was involved in an ATV accident and was taken to the ED at Baptist Health Lexington for care. He was admitted to the hospital as an inpatient for surgical repair of a broken tibia, distal end. The allowable on this hospitalization was $11,736.92 for the hospital. He has only paid $385.45 so far this year in OOP expenses. And, he has paid $299.23 toward the deductible. Total Insurance Consideration - Hospital Bill Amount Running Balance Insurance Allowance (Total) Deductible (Patient) Coinsurance or Copay (Patient) Insurance Payment $0.00 4. Sarah goes to an orthopedic for evaluation of hand pain. The doctor determines that the hands do show indication of osteoarthritis. She was given a prescription to help with this problem. The E/M examination visit has an allowable of $142.00. Total Insurance Consideration Amount Running Balance Insurance Allowance (Total) Deductible (Patient) Coinsurance or Copay (Patient) Insurance Payment $0.00 Basic Insurance Calculations. (6 points each) Deductible $2,500.00 Coinsurance 70/30% Physician Office Visit (non-specialist) - Covers all covered $25.00 services" performed in the office Specialist Office Visit - Covers all "covered services" $35.00 performed in the office Emergency Department (waived if hospitalized as inpatient) $175.00 Urgent Treatment Center $50.00 Inpatient Hospitalizations - Applies separately to all claims After deductible, coinsurance associated with the inpatient hospitalization Outpatient Surgery - Applies separately to all claims After deductible, coinsurance associated with the inpatient hospitalization Physical & Occupational Therapy Visit $25.00 Out-of-Pocket Maximum $5,750.00 1. Brady was having abdominal pain and running a fever so he went to his family physician for an examination. The allowable was $104.56 for the visit. Total Insurance Consideration Amount Running Balance II Insurance Allowance (Total) Deductible (Patient) Coinsurance or Copay (Patient) Insurance Payment $0.00 2. Billy goes to Move Well PT Clinic for his 4 sessions. The allowable for each visit $143.00. How will the total PT bill be handled? Total Insurance Consideration Amount Running Balance Insurance Allowance (Total) Deductible (Patient) Coinsurance or Copay (Patient) Insurance Payment $0.00 3. Jarrett was involved in an ATV accident and was taken to the ED at Baptist Health Lexington for care. He was admitted to the hospital as an inpatient for surgical repair of a broken tibia, distal end. The allowable on this hospitalization was $11,736.92 for the hospital. He has only paid $385.45 so far this year in OOP expenses. And, he has paid $299.23 toward the deductible. Total Insurance Consideration - Hospital Bill Amount Running Balance Insurance Allowance (Total) Deductible (Patient) Coinsurance or Copay (Patient) Insurance Payment $0.00 4. Sarah goes to an orthopedic for evaluation of hand pain. The doctor determines that the hands do show indication of osteoarthritis. She was given a prescription to help with this problem. The E/M examination visit has an allowable of $142.00. Total Insurance Consideration Amount Running Balance Insurance Allowance (Total) Deductible (Patient) Coinsurance or Copay (Patient) Insurance Payment $0.00