A patient with a high-deductible consumer-driven health plan has met half of the $1,000 annual deductible before requiring surgery to repair a broken ankle while visiting a neighboring state. The out-of-network physician’s bill is $4,500. The PPO that takes effect after the deductible has been met is an 80-20 in-network plan and a 60-40 out-of-network plan. How much does the patient owe? How much should the PPO be billed?

Question
Asked Apr 8, 2019

A patient with a high-deductible consumer-driven health plan has met half of the $1,000 annual deductible before requiring surgery to repair a broken ankle while visiting a neighboring state. The out-of-network physician’s bill is $4,500. The PPO that takes effect after the deductible has been met is an 80-20 in-network plan and a 60-40 out-of-network plan. How much does the patient owe? How much should the PPO be billed?

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Expert Answer

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Step 1

The out-of-network physician’s bill is $4,500.

Bill substract the deductible still owed that is 4,500-500(half of the $1,000 annual deductible )=$4,000.

 

Step 2

The plan will pay 60 percent out of network amount of 4000 which is 2400, which is shown below:

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Step 3

The plan will pay 40 percent out of network amount of 4000 which is 1600, which is shown below:

So, this means the patient will pay  ...

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