For parts (a) and (b) assume the employee utilizes the medical services listed below over the course of the plan year. Total medical spending here indicates the total amount that the hospital and physicians receive, which are paid for in part by the insurer and in part by the patient. For the MRI, assume the person did NOT call ahead and get the MRI approved Total Medical Spending Service 1 visit to Hosp. ER; ER Hosp. charges (not admitted) ER Physician Charges 1 Outpatient X-ray to diagnose a broken arm 1 MRI to evaluate tissue damage (didn't call ahead) Other Diagnostic tests Outpatient procedures on the arm 750 S 395 S 215 $1,330 $1,700 $5,500 Calculate this person's out of pocket spending on care if all services were performed within the BCBS network. Out of pocket spending is the total spent on copays, deductibles, and coinsurance (but don't include premiums here). And remember that copay amounts don't contribute to the deductible and are not subject to coinsurance a. b. Calculate this person's out of pocket spending on care if all services were performed outside of the BCBS network. Draw a graph with out of pocket (OOP) spending on the vertical axis, and total medical spending on horizontal axis. Do not include premiums in the out-of-pocket payments. Graph the relationship between total medical spending and OOP for a single employee who does not enroll other family members on her plan. Be sure to indicate the annual OOP maximum. Make the following simplifying assumptions, as the real rules are quite complex: Assume all care is in-network. Assume the coinsurance rate is 20% c. regardless of service type, even though in reality it varies across services. Assume she never has to pay a copayment. d. Assuming the simplifications described in (c), what is the total medical spending that the patient would have to incur before she reached her annual out of pocket maximum? Total medical spending is the amount that the hospital and physicians receive, which is equal to the amount that the insurer and patient (added together) pay For parts (a) and (b) assume the employee utilizes the medical services listed below over the course of the plan year. Total medical spending here indicates the total amount that the hospital and physicians receive, which are paid for in part by the insurer and in part by the patient. For the MRI, assume the person did NOT call ahead and get the MRI approved Total Medical Spending Service 1 visit to Hosp. ER; ER Hosp. charges (not admitted) ER Physician Charges 1 Outpatient X-ray to diagnose a broken arm 1 MRI to evaluate tissue damage (didn't call ahead) Other Diagnostic tests Outpatient procedures on the arm 750 S 395 S 215 $1,330 $1,700 $5,500 Calculate this person's out of pocket spending on care if all services were performed within the BCBS network. Out of pocket spending is the total spent on copays, deductibles, and coinsurance (but don't include premiums here). And remember that copay amounts don't contribute to the deductible and are not subject to coinsurance a. b. Calculate this person's out of pocket spending on care if all services were performed outside of the BCBS network. Draw a graph with out of pocket (OOP) spending on the vertical axis, and total medical spending on horizontal axis. Do not include premiums in the out-of-pocket payments. Graph the relationship between total medical spending and OOP for a single employee who does not enroll other family members on her plan. Be sure to indicate the annual OOP maximum. Make the following simplifying assumptions, as the real rules are quite complex: Assume all care is in-network. Assume the coinsurance rate is 20% c. regardless of service type, even though in reality it varies across services. Assume she never has to pay a copayment. d. Assuming the simplifications described in (c), what is the total medical spending that the patient would have to incur before she reached her annual out of pocket maximum? Total medical spending is the amount that the hospital and physicians receive, which is equal to the amount that the insurer and patient (added together) pay