11.2: Health Insurance Benefits - HITCHENS

11.2: Health Insurance Benefits

Objective: SWBAT compute the amount the patient pays for health care. Just because you have health insurance doesn't mean all procedures are covered. In fact, the insurance plan and the state you live in determine the services provided. For example, you might have difficulty securing health insurance to cover infertility treatment and pre-existing conditions such as congenital heart disease. Health insurance policies have an annual deductible, which is the amount of money you must pay each year before your insurance company starts paying. Some health care services also have a co-insurance clause. This requires you to pay a certain percent of medical expenses after a deductible has been paid. For example, an 80 percent co-insurance clause means your insurance company pays 80 percent of the cost and you pay 20 percent of the cost. You might also hear about a co-payment. This is usually a predetermined flat fee you pay for health care services. This is normally a flat fee, NOT a percent like the co-insurance clause. For example, you might have a $15 "co-pay" for visiting your doctor regardless of the type of service provided. This is the most common form of payment. Make sure you remember: Amount Paid by Patient = Deductible + Co-pays + Co-insurance amount + Hospital Charges Warm Up: We pay a premium for insurance but that isn't the only thing that we pay. We have to pay each time we visit the doctors or meet a certain deductible. What are some ways that you could reduce the premium each month?

Adapted for Education purposes from Glencoe Mathematics with Business Applications. 2015

Example 1: Brooke Swanson is single and has a health insurance plan with the benefit shown in 11-charts. Her recent network health care costs include co-payments for 8 physician visits and 9 specialists visits. Following hospital surgery, she made co-payments for 12 physical therapy visits, and she has 75 home visits from a nurse at $55 each. Her hospital admission charge was $200 and her hospital bill was $14,560. What amount did she pay?

Step 1: Find the deductible. The deductible is $300. Deductible

Step 2: Find the cost of the co-payments. Physician + Specialist + Physical Therapy

($10 X 8) + ($20 X 9) + ($15 X 12) $80 + $180 + $180

= = $440.00 Cost of Co-payments

Step 3: Find the co-insurance amount for the home health care.

(Note: Co-insurance requires the insurance company to pay 80% and the patient pay 20%)

$55 X (75 ? 50) X 20% =

$55 X 25 X 20% = $275.00 Co-insurance for health care

Step 4: Find the hospital charges. (Normally, the patient pays a small percentage such as 10%)

$14,560 X (100% - 90%) + $200 =

$14,560 X 10% + $200 = $1,656 Hospital Charges

Step 5: Find the total amount paid by the patient.

Deductible + Co-payments + Co-insurance Amount + Hospital Charges

$300 + $440 +

$275

+ $1,456

= $2,671.00 Total Paid by patient.

Self Check Answers: 1. Co-payments = $735 2. Hospital Charges = $126 3. Total amount paid by patient = $1,761

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download