05.07.2022 - 19:28

# Stephanie was injured in a car accident and was rushed to the emergency room. She received stitches for a facial wound and treatment for a broken finger. Under Stephanie’s PPO plan, emergency room car

Question:

Stephanie was injured in a car accident and was rushed to the emergency room. She received stitches for a facial wound and treatment for a broken finger. Under Stephanie’s PPO plan, emergency room care at a network hospital is 70 percent covered after the member has met a $490 annual deductible. Assume that Stephanie went to a hospital within her PPO network. Her total emergency room bill was$1,440.

a. What amount did Stephanie have to pay?

b. What amount did the PPO cover?

Answers (1)
• April 13, 2023 в 09:16
a. Stephanie had to pay a total of $637 out of pocket. This is calculated by subtracting her deductible ($490) from her total bill ($1,440) to get$950, then multiplying that amount by her coinsurance (30%), which comes out to $285. She then adds her deductible ($490) to her coinsurance ($285) to get her total out-of-pocket cost ($775), but since her plan only covers emergency room care at a network hospital up to 70%, she must pay the remaining 30% of $1,440, which is$432. So her total out-of-pocket cost is $775 +$432 = $1,207. But since her deductible is already accounted for in the coinsurance calculation, we only need to add that part to get the final answer of$637. b. The PPO covered a total of $803. This is calculated by subtracting the out-of-pocket cost Stephanie paid ($637) from the total bill (\$1,440).
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