Your patient's health insurance policy requires an annual $200 deductible, an 80 percent coinsurance provision and a $2,000 out-of-pocket cap on medical expenses recognized by the insurer. If the total surgery bill was $15,000, how much will the insurance company pay? Assume that this is the first medical expense of the calendar year.

Question

Quizplus · Accepted Answer

The patient must pay the $200 deductible first. The remaining balance is $14,800.

80% of $14,800 is $11,840, which is the amount the insurer will pay.

However, the patient has a $2,000 out-of-pocket cap, which means they only have to pay $2,000 in total for medical expenses recognized by the insurer.

So the insurer will pay $11,840 and the patient will pay $2,000, for a total payment of $13,840.

Therefore, the best answer is C) $12,800, which is the amount the insurer will pay after the patient has paid the deductible and reached the out-of-pocket cap.

Your Patient's Health Insurance Policy Requires an Annual $200 Deductible