Henry visited the doctor's office last week because of a persistent cough and difficulty breathing. The bill has arrived and Henry can see that he was charged by his physician for the visit as well as radiology for an x-ray of his lungs and the laboratory for tests on his blood sample. The combined fees billed for the visit, the x-ray, and the lab tests is $475. With previous health care visits this year, Henry has already met his annual deductible of $200 and has accumulated $700 toward his co-insurance cap in previous bills he has paid.

Use the following information to calculate the portion of the bill to be covered by Henry's insurance provider.

annual deductible $200 (previously met) co-insurance split 80/20 (insurance 80%/Henry 20%) co-insurance cap $1,000 (before this visit, Henry had paid $700 in co-insurance so far this year)

teachers note:

1. determine Henry's coinsurance payment as it compares to his coinsurance cap

Henry's coinsurance payment = (total- remaining deductibles)* Henry's coinsurance proportion

-- Remember, Henry's deductible has already been met so the remaining deductible would be $0--

You need to compare Henry's coinsurance payment to his coinsurance cap, but you must account for the fact that he has already accrued $700 toward his $1,000 cap

remaining coinsurance before reaching the cap = $1,000 - $700 which is $300

compare Henry's coinsurance payment to the $300 remaining on his coinsurance cap

IF Henry has not yet reached his coinsurance cap then:

the insurance company pays = (total - remaining deductible)* insurance company's coinsurance pre-cap proportion of 80%

IF Henry has met his coinsurance cap then:

Insurance company pays = (total - remaining deductible)* insurance company's coinsurance post-cap proportion of 100%