medical insurance amount is paid to the provider? By whom? 2. Barbara Saxton req
ID: 239462 • Letter: M
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medical insurance amount is paid to the provider? By whom? 2. Barbara Saxton required a chest X-ray, two views, CPT code the local BCBS POS provider charges $164. Her provider participates in plan. The POS plan reimburses using a contracte CPT code 71020 is $120. What amount is paid to the provide amount is billed to the patient? r? What Benton Button's employer provides an HSA to accompany his deductible is $1,500 per year (which is not yet met) and coinsurance is Benton may seek treatment from any provider. He is contemplating necessary surgery with three different providers. Provider X charges $11,294; Provider Y charges $10,960; and Provider Z charges $11,318. Providers X and Y offer as an additional incentive a 5 percent discount for payment up front. 3. A. What is the charge for each provider? B. What amount will Benton be required to pay? For these questions, refer to Figure 8.2 in your textbook. Iris and Hector Guzman and their children are new patients covered by the PPO. Their copayment is $10 for office visits. They have an annual deductible of $500 for out-of-network charges as well as coinsurance of 80-20. .Explanation / Answer
2. BCBS POS Plan (Blue Cross Blue Shield - Point of service plan)
BCBS POS is an HMO (Health maintenance organization ) plan with added POS benefits.
It can be considered as the hybrid of HMO and PPO plans. In it, the participants designate a physician from in network to be their primary care provider (PCP) and like PPO participants can go outside of the provider network for rendering the service. It adds to the flexibility of service.
Usually, the patient needs a referral to go outside the network, but in some situations, they can go even without a referral as in the Blue Cross and Blue Shield of Texas HMO POS plan.
Contracted fee schedule: It is the complete list of fees used by Medicare to pay doctors or provider. The fee maximum is used to reimburse a provider.
Amount paid to the provider is $120, As the scheduled fee for the CPT code 71020 is $120.
Barbara Saxton is billed with $ 44. The total cost of the procedure is $164. (164-120)
3.
HDHP (High deductible health plan is the kind of health insurance with low premiums and high deductibles than traditional health insurances. For having health savings account you need an HDHP. HDHPs are intended to pay catastrophic illnesses even though some may offer wellness benefits.
A. Cost of surgery by provider X: $11294
Cost of surgery by provider Y: $10960
Cost of surgery by provider Z: $11318
5% discount for payment up front for X and Y
If paid up front:
Cost of surgery by provider X : $11294 - $564.7 = $10729.3
Cost of surgery by provider Y : $10960 - $548 = $10412
B.
Coinsurance is 75-25.
Coinsurance is the insurance agencies and participants contribution.
Benton required paying,
if choosing provider X : $ 2823.5 (25% of $11294)
if paying up front, he has to pay $2682.325 (25% of 10729.3 after discount )
if choosing provider Y: $2740 (25% of 10960)
if paying up front, he has to pay (after discount): $2603 (25% 0f $10412)
If choosing provider Z: $2829.5 (25% of $11318)
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