Medical Insurance 7th Edition by Amy Blochowiak, Joanne Valerius, Nenna Bayes, Cynthia Newby

Exercise 14

Calculating Insurance Math
Dr. Mary Mandlebaum is a PAR provider in Medicare and in Mountville Health Plan, which has allowed charges for services and does not permit balance billing of plan members. She is not a PAR provider in the Ringdale Medical Plan. Based on the following table of charges, calculate the charges that the payer and the patient will pay in each of the situations. Show your calculations.
A. Insurance Plan: Mountville Health Plan; patient has met annual deductible of $250; 80-20 coinsurance
Services: CPT 99203, 90700
Payer Reimbursement: ____________ Patient Charge: ____________
B. Insurance Plan: Mountville Health Plan; patient has paid $125 toward an annual deductible of $500;
80-20 coinsurance
Services: CPT 99215, 93040, 94010
Payer Reimbursement: ____________ Patient Charge: ____________
C. Insurance Plan: Ringdale Medical Plan A; no deductible or coinsurance; copayment of $5/PAR; $25/NonPAR
Services: CPT 99212
Payer Reimbursement: ____________ Patient Charge: ____________
D. Insurance Plan: Ringdale Medical Plan B; patient has met annual deductible of $300; 80-20 coinsurance
Services: CPT 99215
Payer Reimbursement: ____________ Patient Charge: ____________
E. Insurance Plan: Medicare; annual deductible has been met by patient
Services: 99213, 93040
Payer Reimbursement: ____________ Patient Charge: ____________