Calculate the patient out-of-pocket obligations for each situation. The health insurance policy has the following characteristics:

• Office visit copays: $25 in-network and $50 out-of-network
• Coinsurance 80/20 for in-network, meaning the patient pays 20% and the insurance company 80%. The out-of-network patient pays 100%
• Deductible $2,000
• Out-of-pocket maximum $10,000
• Emergency room copay $150 for in-network or out-of-network
• Urgent care copay $50 for in-network or out-of-network
• Prescriptions $10 for generic and $30 for formulary

Sophia starts to experience serious symptoms that convince her to visit an urgent care facility. During the visit, the doctor encourages Sophia to go to the hospital. Sophia is admitted to the hospital and receives services in the amount of $30,000 (allowable charges only $12,000). She also picks up a prescription (generic) for pain relief that she gets refilled one additional time. Sophia has not had any charges apply to her deductible yet.

How much is Sophia obligated to pay out-of-pocket?

Answer rating: 100% (QA)

To calculate Sophias outofpocket obligations we need to consider the different aspects of her hea... View the full answer