Policy Information

Deductible: $$2,500\mathrm{.}00$

Copayments: $($Only the services listed below are copayments $-$ All others services are coinsurance$)$

In$-$Network Primary Care Physician Office Visit:

$$25\mathrm{.}00$

In$-$Network Specialist Physician Office Visit:

$$35\mathrm{.}00$

In$-$Network Emergency Department Visits:

$$500\mathrm{.}00$

In$-$Network Outpatient Therapy Visit:

$$50\mathrm{.}00$

Urgent Care Center Visit:

$$75\mathrm{.}00$

Outpatient Surgery Center

$$750\mathrm{.}00$

Coinsurance: $,\frac{70}{30}\%($All other healthcare services are paid under coinsurance$)$

Maximum Out$-$Of$-$Pocket $($OOP$)$: $$4,500\mathrm{.}00$

Alvin went to his PCP$.$ The allowable for the pediatrician was $$63\mathrm{.}72.$ How will the payment to physician take place?

Patient's Annual Year$-$to$-$Date Summary Prior to This Encounter:

Toward Deductible: $$556\mathrm{.}00$

Remaining Maximum OOP: $$3,025\mathrm{.}00$

Focus