You reviewed the claim form for Lisa Smith for treatment of hyperglycemia. You discover she received treatment from a non-network provider. She has met her annual deductible. Total charges for the date of services are $170. The plan pays at usual and customary which is exactly what was billed. Her benefits are as follows:

PPO medical care office visit                     in network benefit office visit copayment $10.00                      out of network deductible and coinsurance of 20%

calculate the expected reimbursement from insurance and her coinsurance

 

 

You are reviewing a claim for maria Johnson, a 45 year old who received a well check and flu shot from her in network provider. Her benefitsare as follows:

PPO medical care office visits              in network benefit copayment: Office visit $10 and injections $25                    out of network deductible and coinsurance of 20%

Mrs. Johnson called the office because she thought she had overpaid during her visit. What was Mrs. Johnson's copay the date of the visit?

 

 

You are reviewing the vision exam benefits for Zach Bergman. He presented for an eye exam stating he needed new glasses. He had an examination 13 months prior and notes he can have an exam every year. His benefits are as follows:

PPO medical care office visits               in network benefits one vision exam every 2 calendar years.               out of network deductible and coinsurance of 20%.

                                                                                                                                                                                              covered every 2 calendar years.

What is Mr. Bergmans benefits?

 

Lisa Smith called your office noting she had to be transported to the hospital by ambulance while on vacation for food poisoning. She was concered about what she will need to pay out of pocket. She was not admitted. Her benefits for emergency treatments are as follows:

PPO emergency treatment          in network benefit copay $100. Waived if admitted.                        out of network copay$100. Wavied if admitted.

                                                          ambulance services no charge.                                                             ambulance services noo charge

what should Lisa Smith expect to pay out of pocket?