Roger Strader works for a small manufacturing company and is married to Amy, who were high school sweethearts and are both currently 64 years old. He receives an annual salary of $80,000 and Amy works as an administrative assistant at a law firm and makes $30,000 annually.

Amy has medical coverage through her employer and Roger's company purchased health insurance for each of their employees. The plan is a PPO with a $2,000 deductible, 80% co-insurance, $25 office copays, pharmacy benefits, and a maximum out-of-pocket limit of $7,000. It is an ACA plan and provides free preventive health services that Roger routinely utilizes.

One day as Roger was cutting a tree limb from a tree in his yard, he slipped and the chain saw fell on his leg. Roger was rushed to the local hospital where he underwent surgery and then spent 15 days in the hospital. The ride in the ambulance cost $1,000. Surgery and anesthesia were $45,000; hospital room and board cost $800 per day. Drugs and rehabilitative care came to $15,000.

Summary

PPO Insurance Plan Benefits
Deductible	$2,000
Coinsurance	80%
Room & Board	$800 per day
Out of Pocket Max	$7,000
Lifetime Max	Unlimited

 

Expenses
Ambulance	$1,000
S & A	$45,000
Room & Board	$800 per day x 15 = $12,000
Drugs & Rehab	$15,000
	Total: $73,000

If Roger's plan was an HSA with the following benefits, how much would he have to pay and what would the insurance company pay?

HSA Insurance Plan Benefits
Deductible	$4,000
Coinsurance	100%
Lifetime Max	Unlimited

1. 
   
2. Read the case above.
3. 
   
4. Compose a document in which you answer the questions embedded in the case.

How much of Roger's medical bills will be paid under his insurance policy and how much must he pay personally?

Answer rating: 100% (QA)

According to the given information Rogers PPO insurance plan has a 2000 deductible 80 coinsurance an... View the full answer