Insurance Plan: Mountville Health Plan; patient has met annual deductible of $250;80-20 coinsurance.
Services:
CPT codes: 99203 and 90700.
Usual charges are: $100& $102.
Allowed charges are:$89 & $87
How do you calculate between the two
298
298
urance Plan: Mountville Health Plan; patient has met annual deductible of $250; 80-20 coinsurance
Services: CPT 99203, 90700
Payer Reimbursement: ____________ Patient Charge: ____________
20$,$
30.80
To calculate the cost for the patient, we need to understand how the insurance plan works and what the terms mean.
1. Annual Deductible: The annual deductible is the amount that the patient needs to pay out-of-pocket before the insurance coverage starts. In this case, the patient has met the deductible of $250.
2. Coinsurance: The coinsurance is the cost-sharing percentage between the insurance company and the patient after the deductible is met. If the coinsurance is 80-20, it means the insurance company will cover 80% of the allowed charges, and the patient is responsible for the remaining 20%.
Now, let's calculate the patient's cost for each service using the given information:
Service 1:
CPT Code: 99203
Usual Charge: $100
Allowed Charge: $89
Since the patient has already met the deductible, the insurance plan will cover 80% of the allowed charge, which is (80/100) x $89 = $71.20. The patient is responsible for the remaining 20%, which is $17.80.
Service 2:
CPT Code: 90700
Usual Charge: $102
Allowed Charge: $87
Similarly, the insurance plan will cover 80% of the allowed charge, which is (80/100) x $87 = $69.60. The patient is responsible for the remaining 20%, which is $17.40.
To summarize, for each service, the patient would need to pay $17.80 and $17.40, respectively.