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Insurance Simulation Read the description of one family's hoanthcare usage listed below. Then answer the questions that follow. Family's healthcare usage last yoar: Marta is a single mother who works as an administrator in a suburban school. Her healthcare usage included the following: - annual physical with PCP, generic prescription (+11 relills) - PCP visit tor chronic headaches - follow-up visit to PCP for headaches, proscription tier 2 brand name (+2 refils ) - optometrist visit for eye exam and purchase of single-vision glasses (\$170) - teeth cleaning every 6 months, one amagam filling (\$150) Her 16 -yearold son is a junlor In high school and plays soccer. His healthcare usage included the following: - annual sports physical with PCP - dermatology visit, referral from PCP-generic acne medicine prescribed ( +5 refils) - ambulance ride to emergency room-knocked out playing sports; released atier exam - PCP visit for follow-up on concussion - PCP visit for flu symptoms - Teeth cleaning every 6 months, bite-wing X-rays Her 10-year-old daughter is in 5 th grade and wears glasses. Her healihcare usage included the following: - annual physical with PCP and one Immunization - urgent care visit for a skateboarding accident, sprained ankle, X-ray, \$40 crutches - optometrist visit, replaced broken glasses that were over one year old, $95 - two follow-up visits with PCP for sprained ankle - physical therapy, referral from PCP-four 1-hour therapy and assessment visits - teoth cleaning every 6 months, fluoride treatment - orthodontist visit to put on braces, billed at $250 imonth for one year Her youngest is 2 years old. His healthcare usage included the following: - two well-baby checkups ( 18 months and 2 years) and three immunizations - urgent care visit for ear infections, generic antibiotic prescribed - urgent care visit for ear infection, tier 2 brand name antibiotic prescription (no refili) - PCP visit for follow-up on ear infections - ENT specialist visit, referral from PCP for chronic ear infections - day surgery for tubes in ears (\$12,000), generic prescription of antiblotic ear drops - follow-Up visit with ENT specialist after surgery 1. How many times did the family see a primary care provider (PCP)? 2. How many times did the family see a specialist? 3. How many times did the famly go to the emergency room or use an ambulance? Wore they admitted to the ER? 4. How many times was the family prescribed each of the following prescriptions? generic tier 2 non-formulary 5. What was the actual cost of all the durable medical equipment and glasses this family required in the year? Copyrght Goodhest Wiloox Co., Ine. 38 Chapter 4 Professional Knowledge in Health Informatics 6. Which plan is the best choice for this family? Why? 7. Which plan would lkely be cheapest for a healthy middle-aged couple without children? 8. Which plan would allow the most flexibility for someone with unusual healthcare needs? Copytigh doodheert wiles Co, lac. i0 Chapter 4 Professional Knowledge in Health Informatics Muy not be ieproduced ar postod lo a publichy actestitio websho. 9 Insurance Simulation Read the description of one family's hoanthcare usage listed below. Then answer the questions that follow. Family's healthcare usage last yoar: Marta is a single mother who works as an administrator in a suburban school. Her healthcare usage included the following: - annual physical with PCP, generic prescription (+11 relills) - PCP visit tor chronic headaches - follow-up visit to PCP for headaches, proscription tier 2 brand name (+2 refils ) - optometrist visit for eye exam and purchase of single-vision glasses (\$170) - teeth cleaning every 6 months, one amagam filling (\$150) Her 16 -yearold son is a junlor In high school and plays soccer. His healthcare usage included the following: - annual sports physical with PCP - dermatology visit, referral from PCP-generic acne medicine prescribed ( +5 refils) - ambulance ride to emergency room-knocked out playing sports; released atier exam - PCP visit for follow-up on concussion - PCP visit for flu symptoms - Teeth cleaning every 6 months, bite-wing X-rays Her 10-year-old daughter is in 5 th grade and wears glasses. Her healihcare usage included the following: - annual physical with PCP and one Immunization - urgent care visit for a skateboarding accident, sprained ankle, X-ray, \$40 crutches - optometrist visit, replaced broken glasses that were over one year old, $95 - two follow-up visits with PCP for sprained ankle - physical therapy, referral from PCP-four 1-hour therapy and assessment visits - teoth cleaning every 6 months, fluoride treatment - orthodontist visit to put on braces, billed at $250 imonth for one year Her youngest is 2 years old. His healthcare usage included the following: - two well-baby checkups ( 18 months and 2 years) and three immunizations - urgent care visit for ear infections, generic antibiotic prescribed - urgent care visit for ear infection, tier 2 brand name antibiotic prescription (no refili) - PCP visit for follow-up on ear infections - ENT specialist visit, referral from PCP for chronic ear infections - day surgery for tubes in ears (\$12,000), generic prescription of antiblotic ear drops - follow-Up visit with ENT specialist after surgery 1. How many times did the family see a primary care provider (PCP)? 2. How many times did the family see a specialist? 3. How many times did the famly go to the emergency room or use an ambulance? Wore they admitted to the ER? 4. How many times was the family prescribed each of the following prescriptions? generic tier 2 non-formulary 5. What was the actual cost of all the durable medical equipment and glasses this family required in the year? Copyrght Goodhest Wiloox Co., Ine. 38 Chapter 4 Professional Knowledge in Health Informatics 6. Which plan is the best choice for this family? Why? 7. Which plan would lkely be cheapest for a healthy middle-aged couple without children? 8. Which plan would allow the most flexibility for someone with unusual healthcare needs? Copytigh doodheert wiles Co, lac. i0 Chapter 4 Professional Knowledge in Health Informatics Muy not be ieproduced ar postod lo a publichy actestitio websho. 9