Basic Calculation Assignment (In-Network) Name: Policy Information Deductible: $1,250.00 Copayments: (Only the services listed below are copayments - All others services are coinsurance) In-Network Primary Care Physician Office Visit: $20.00 In-Network Specialist Physician Office Visit: $30.00 In-Network Emergency Department Visits: $250.00 In-Network Outpatient Therapy Visit: $20.00 Urgent Care Center Visit: $65.00 Coinsurance: 80/20% (All other healthcare services are paid under coinsurance) Maximum Out-Of-Pocket (OOP): $4,000.00 As Gwen (from #3) was recovering from her fall, she was referred to a physical therapy clinic and had 5 visits. The allowable for each visit was $54.00. How will the payment to the Movewell Physical Therapy take place (consider all payments together)? Patient's Annual Year-to-Date Summary Prior to This Encounter: Toward Deductible: $1,250.00 Remaining Maximum OOP: $831.45 Total Insurance Consideration Amount Running Balance Insurance Allowance (Total) $ Deductible (Patient) $ $ Coinsurance/Copayment (Patient) $ $ Insurance Payment $ $ $ 5. In December, George was diagnosed with pneumonia and was admitted into Central State Medical Center for four days. The allowable for the hospital was $24,468.00. How will the payment to Central State take place? Patient's Annual Year-to-Date Summary Prior to This Encounter: Toward Deductible: $431.11 Remaining Maximum OOP: $2788.13 Patient's Annual Year-to-Date Summary Prior to This Encounter: Toward Deductible: $431.11 Remaining Maximum OOP: $2788.13 Total Insurance Consideration Amount Running Balance Insurance Allowance (Total) $ Deductible (Patient) $ $ Coinsurance/Copayment (Patient) $ $ Insurance Payment $ $ Karie woke up with a sore throat, coughing and a fever. Karie went to her family physician (Dr. Towns) and it was confirmed from a throat culture that she had strep throat. The allowable for Dr. Towns was $109.00. How will the payment to Dr. Towns take place? Patient's Annual Year-to-Date Summary Prior to This Encounter: Toward Deductible: $65.00 Remaining Maximum OOP: $3,935.00 12 Paragraph Styles 5 Vo Total Insurance Consideration Amount Running Balance Insurance Allowance (Total) $ Deductible (Patient) $ $ $ Coinsurance/Copayment (Patient) $ $ Insurance Payment $ $ 7. Larry has been experiencing severe joint pain and went to an orthopedist. The allowable for this visit was $157.12. How will the payment to the Dr. Harrison take place? Patient's Annual Year-to-Date Summary Prior to This Encounter: Toward Deductible: $946.33 Remaining Maximum OOP: $2,989.45 Total Insurance Consideration Amount Running Balance Insurance Allowance (Total) $ Deductible (Patient) $ $ Coinsurance/Copayment (Patient) $ S Insurance Payment $ Basic Calculation Assignment (In-Network) Name: Policy Information Deductible: $1,250.00 Copayments: (Only the services listed below are copayments - All others services are coinsurance) In-Network Primary Care Physician Office Visit: $20.00 In-Network Specialist Physician Office Visit: $30.00 In-Network Emergency Department Visits: $250.00 In-Network Outpatient Therapy Visit: $20.00 Urgent Care Center Visit: $65.00 Coinsurance: 80/20% (All other healthcare services are paid under coinsurance) Maximum Out-Of-Pocket (OOP): $4,000.00 As Gwen (from #3) was recovering from her fall, she was referred to a physical therapy clinic and had 5 visits. The allowable for each visit was $54.00. How will the payment to the Movewell Physical Therapy take place (consider all payments together)? Patient's Annual Year-to-Date Summary Prior to This Encounter: Toward Deductible: $1,250.00 Remaining Maximum OOP: $831.45 Total Insurance Consideration Amount Running Balance Insurance Allowance (Total) $ Deductible (Patient) $ $ Coinsurance/Copayment (Patient) $ $ Insurance Payment $ $ $ 5. In December, George was diagnosed with pneumonia and was admitted into Central State Medical Center for four days. The allowable for the hospital was $24,468.00. How will the payment to Central State take place? Patient's Annual Year-to-Date Summary Prior to This Encounter: Toward Deductible: $431.11 Remaining Maximum OOP: $2788.13 Patient's Annual Year-to-Date Summary Prior to This Encounter: Toward Deductible: $431.11 Remaining Maximum OOP: $2788.13 Total Insurance Consideration Amount Running Balance Insurance Allowance (Total) $ Deductible (Patient) $ $ Coinsurance/Copayment (Patient) $ $ Insurance Payment $ $ Karie woke up with a sore throat, coughing and a fever. Karie went to her family physician (Dr. Towns) and it was confirmed from a throat culture that she had strep throat. The allowable for Dr. Towns was $109.00. How will the payment to Dr. Towns take place? Patient's Annual Year-to-Date Summary Prior to This Encounter: Toward Deductible: $65.00 Remaining Maximum OOP: $3,935.00 12 Paragraph Styles 5 Vo Total Insurance Consideration Amount Running Balance Insurance Allowance (Total) $ Deductible (Patient) $ $ $ Coinsurance/Copayment (Patient) $ $ Insurance Payment $ $ 7. Larry has been experiencing severe joint pain and went to an orthopedist. The allowable for this visit was $157.12. How will the payment to the Dr. Harrison take place? Patient's Annual Year-to-Date Summary Prior to This Encounter: Toward Deductible: $946.33 Remaining Maximum OOP: $2,989.45 Total Insurance Consideration Amount Running Balance Insurance Allowance (Total) $ Deductible (Patient) $ $ Coinsurance/Copayment (Patient) $ S Insurance Payment $