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Besides possibly paying the premiums for a medical insurance plan, the insured is almost always responsible for making other, out-of-pocket payments. This practice helps keep overall costs down for both insureds and the insurance companies and ensures that insureds are informed about the costs of health care. For each of the following scenarios, select which type of other cost or provision is illustrated. Deborah has been hospitalized for an illness. Her insurance company has started paying 80% of covered medical expenses. O Coordination of benefits Deductible O Internal limits O Participation (co-insurance) Felix is covered under his medical insurance policy at work and also covered under his spouse's work plan. Felix has some large medical bills and since both Felix and his spouse contribute to their plans at work, Felix is trying to figure out a way to collect benefits for some of the same charges under both plans. Internal limits Deductible O Participation (co-insurance) O Coordination of benefits Janet had routine surgery performed at her local hospital. All charges were within the reasonable and customary costs in she area. Coordination of benefits O Internal limits Deductible O Participation (co-insurance) Larry had a run of bad luck. He sprained his arm, had a staph infection, and needed surgery to remove his appendix. Out-of-pocket, Larry has paid $300 for the sprain, $500 for the infection, and $1,200 for the operation. He still has medical expenses for all three incidents. his insurance company is now paying part of the expenses related to the surgery but not the other two incidents. What does Larry's responsibility for still paying all expenses for the sprain and infection represent? O Coordination of benefits O Internal limits O Deductible O Participation (co-insurance) Megan, a graphic artist, is 24 years old and has owned a major medical insurance policy for three years. The policy, which she purchased through her alumni association, provides the following coverage: a $2,000,000 lifetime limit a $500 deductible and 80% coinsurance clause internal limits of $500 per day for a semi-private room and board, $5,000 per occurrence for X-rays, prescription drugs, and other medical expenses, and a $25,000 maximum limit per occurrence on surgical procedures a $25,000 limit per occurrence on rehabilitation and physical therapy if a hospital charges a room rate that is greater than the policy's stated internal limit, the hospital agrees to reduce the room rate to the policy's internal limit. Last month, Megan was injured in an automobile accident. She spent 4 days in the hospital in a room that cost $750 per day, incurred $4,000 for other medical expenses, and $22,000 in surgical expenses. Given these claim costs, complete the following table and answer the related questions Policy Limit Total Claim Hospital charges $500 per day $ $ $ Surgery costs Other medical costs $ Rehabilitation and therapy costs $ $ Deductible $ Co-insurance percentage Total cost of claim Based on this data, the total cost to the insurance company is , while the out-of-pocket cost to Megan is $ How much did Megan save by having her medical insurance policy? Assume that the hospital changed its payment policy to make the patient responsible for the difference between the hospital's room rate and the insurance company's responsibility ($750 per day versus $500 per day). By how much would Megan's out-of-pocket cost for her hospital room change due in hospital billing? O Megan's costs would increase by $400. O Megan's costs would increase by $1,000. Megan's costs would increase by $600. Besides possibly paying the premiums for a medical insurance plan, the insured is almost always responsible for making other, out-of-pocket payments. This practice helps keep overall costs down for both insureds and the insurance companies and ensures that insureds are informed about the costs of health care. For each of the following scenarios, select which type of other cost or provision is illustrated. Deborah has been hospitalized for an illness. Her insurance company has started paying 80% of covered medical expenses. O Coordination of benefits Deductible O Internal limits O Participation (co-insurance) Felix is covered under his medical insurance policy at work and also covered under his spouse's work plan. Felix has some large medical bills and since both Felix and his spouse contribute to their plans at work, Felix is trying to figure out a way to collect benefits for some of the same charges under both plans. Internal limits Deductible O Participation (co-insurance) O Coordination of benefits Janet had routine surgery performed at her local hospital. All charges were within the reasonable and customary costs in she area. Coordination of benefits O Internal limits Deductible O Participation (co-insurance) Larry had a run of bad luck. He sprained his arm, had a staph infection, and needed surgery to remove his appendix. Out-of-pocket, Larry has paid $300 for the sprain, $500 for the infection, and $1,200 for the operation. He still has medical expenses for all three incidents. his insurance company is now paying part of the expenses related to the surgery but not the other two incidents. What does Larry's responsibility for still paying all expenses for the sprain and infection represent? O Coordination of benefits O Internal limits O Deductible O Participation (co-insurance) Megan, a graphic artist, is 24 years old and has owned a major medical insurance policy for three years. The policy, which she purchased through her alumni association, provides the following coverage: a $2,000,000 lifetime limit a $500 deductible and 80% coinsurance clause internal limits of $500 per day for a semi-private room and board, $5,000 per occurrence for X-rays, prescription drugs, and other medical expenses, and a $25,000 maximum limit per occurrence on surgical procedures a $25,000 limit per occurrence on rehabilitation and physical therapy if a hospital charges a room rate that is greater than the policy's stated internal limit, the hospital agrees to reduce the room rate to the policy's internal limit. Last month, Megan was injured in an automobile accident. She spent 4 days in the hospital in a room that cost $750 per day, incurred $4,000 for other medical expenses, and $22,000 in surgical expenses. Given these claim costs, complete the following table and answer the related questions Policy Limit Total Claim Hospital charges $500 per day $ $ $ Surgery costs Other medical costs $ Rehabilitation and therapy costs $ $ Deductible $ Co-insurance percentage Total cost of claim Based on this data, the total cost to the insurance company is , while the out-of-pocket cost to Megan is $ How much did Megan save by having her medical insurance policy? Assume that the hospital changed its payment policy to make the patient responsible for the difference between the hospital's room rate and the insurance company's responsibility ($750 per day versus $500 per day). By how much would Megan's out-of-pocket cost for her hospital room change due in hospital billing? O Megan's costs would increase by $400. O Megan's costs would increase by $1,000. Megan's costs would increase by $600