Answered step by step
Verified Expert Solution
Link Copied!

Question

1 Approved Answer

Margo, age 35, was severely injured in an auto accident. She is covered under her employers preferred provider organization (PPO) plan. The plan has a

Margo, age 35, was severely injured in an auto accident. She is covered under her employers preferred provider organization (PPO) plan. The plan has a $1,000 calendar-year deductible, 80/20 percent coinsurance, and an annual out-of-pocket maximum limit of $3,000. As a result of the accident, Margo incurred the following medical expenses:

Cost of ambulance to the hospital

$500

Hospital bill for a 3-day stay

$24,000

Surgery for broken leg

$5,000

Prescription drugs outside the hospital

$300

Physical therapy for the broken leg

$1,200

In addition, Margo could not work for 1 month and lost $4,000 in earnings.

A) Based on this information, how much will Margo collect for her injury if she receives medical care from healthcare providers who are part of the PPO network? (Assume that all charges shown are the allowable or approved charges by the insurer and all providers are in the PPO network.)

B) Assume that Margos broken leg does not heal properly, and she needs another surgical operation. Margo would like a different surgeon with an outstanding professional reputation to perform the operation. The surgeon is not a member of the PPO network. Will Margos plan pay for the surgery? Explain your answer.

Step by Step Solution

There are 3 Steps involved in it

Step: 1

blur-text-image

Get Instant Access to Expert-Tailored Solutions

See step-by-step solutions with expert insights and AI powered tools for academic success

Step: 2

blur-text-image

Step: 3

blur-text-image

Ace Your Homework with AI

Get the answers you need in no time with our AI-driven, step-by-step assistance

Get Started

Recommended Textbook for

Accounting For Managers And Entrepreneurs

Authors: Charles T. Horngren

8th Edition

1269778684, 9781269778688

More Books

Students also viewed these Accounting questions

Question

Describe variables and various types of measurement scales. P-7

Answered: 1 week ago

Question

=+b) What might you consider doing next?

Answered: 1 week ago

Question

Define offboarding. Why is it important?

Answered: 1 week ago