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Max, age 2 8 , is insured under an individual medical expense policy that is part of a preferred provider organization ( PPO ) network.
Max, age is insured under an individual medical expense policy that is part of a preferred provider organization PPO network. The policy has a calendaryear deductible of $ percent coinsurance, and an annual outofpockef limit of $ Max recently had outpatient arthroscopic surgery on his knee, which he injured in a skiing accident. The surgery was performed in an outpatient surgical center. Max incurred the following medical expenses. Assume that the charges shown are the charges approved by Max's insurer and that all providers are in the PPO network.
Outpatient rays and diagnostic tests $
Covered charges in the surgical center $
Surgeon's fee
$
Outpatient prescription drugs
$
Physical therapy expenses
$
In addition, Max could not work for two weeks and lost $ in earnings.
a Based on the given information, how much of the expenses will be paid by the insurance company?
b How much of the expenses will Max have to pay? Explain your answer.
c Assume that a surgeon who is not in the PPO network actually performed the surgery. Will Mark's policy cover this fee? Explain your answer.
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