Zach Carey was a self-employed window washer earning approximately $700 per week
ID: 2631847 • Letter: Z
Question
Zach Carey was a self-employed window washer earning approximately $700 per week. One day, while cleaning windows on the 8th floor of the Second National Bank Building, he tripped and fell from the saffolding to the pavement below. He sustained severe multiple injuries but miraculously survived the accident. He was immediately rushed to the local hosptial for surgery. He remained there for 60 days of treatment, after which he was allowed to go home for futher recuperation. During is hospital stay, he incurred the following expenses: Surgeon: $2,500 Physician: $1,000 hosptial bill for room and board: $250 per day. nursing services: $1,200 anesthetics: $600 wheelchair rental: $100 ambulance: $150 drugs:$350 Zach has a major medical policy with Medical Benefits Corporation that has a $3,000 deductible clause, and 80% co-insurance clause, internal limits of $180 per day on hospital room and board, and $1,500 as a maximum sergical fee. The policy provides no disability income benefits. 1. Explain the policy provisions as they relate to deductibles, co-insurance- and internal limits. 2. How much should Zach recove from the insurance company? How much must he pay out of his own pocket? 3. Would any other policies have offered Zach additional protection? What about his inability to work while recovering from this injury? 4. Based on the information presented, how would you asses Zach's health care insurance coverage? Explain.
Explanation / Answer
1) There are limits on surgicals and room charges. The patient has to bear 20% of the cost after the deduction of Rs3000/-
2)
3) He should have taken a health insurance coverage which pays him some amount during his disablement in addition to his healthcare expenses.
4) Since he is doing a risky kind of job , the coverage should have been much higher to avoid out-of-pocket expenses.
Cost Heads Unit Total Claim Limit Surgeon 2500 2500 1500 Physician 1000 1000 hosptial bill for room and board/day 250 15000 10800 Medical Benefits Corporation that has a $3,000 deductible clause, and 80% co-insurance clause, internal limits of $180 per day on hospital room and board, and $1,500 as a maximum sergical fee nursing services 1200 1200 He remained there for 60 days of treatment anesthetics 600 600 wheelchair rental: 100 100 ambulance 150 150 drugs: 350 350 20900 Total Cost incuding bill for room for insurance calculation 15700 Insurance amount receivable=( 15700-3000)*0.80 10160 Out of pocket expenses=20900-10160 10740Related Questions
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