Your health care coverage is with a PPO.For approved,in-network providers your deductible is $500 and your coinsurance provision is 80%.For out-of-network providers,your deductible is $1,000 and your coinsurance provision is 70%.Assume there is no co-pay provision and you have no other claims this calendar year.You have decided to go to a specialist that is not in the network and the bill is $1,400.How much will you have to pay out-of-pocket?

Question

Quizplus · Accepted Answer

First, you pay the out-of-network deductible of $1,000. The remaining $400 is then subject to the 70% coinsurance, meaning the insurance pays 70% of $400 ($280), and you pay 30% of $400 ($120). So, your total out-of-pocket cost is $1,000 (deductible) + $120 (your share of coinsurance) = $1,120.

Your Health Care Coverage Is with a PPO