Question

A member in an indemnity BCBS plan has an individual deductible of $250 and a family deductible of $500, with a coinsurance rate of 70 percent after the deductible has been met, up to an annual maximum out-of-pocket amount of $1,000. Calculate the total amount the patient owes if their first charges of the year total $3,200.

Answer 1

The total amount the patient owes is $1,135.

Step-by-step explanation:

In this case, the member of the indemnity BCBS plan has a personal deductible of $250 and a family deductible of $500. The coinsurance rate after the deductible is 70%, which means the insurance will cover 70% of the charges and the patient will be responsible for paying 30%. The plan also has an annual maximum out-of-pocket amount of $1,000.

Now, let's calculate the total amount the patient owes:

1. First, the patient needs to meet their deductible. Since the charges are $3,200 and the individual deductible is $250, the patient will pay the full $250 towards the deductible.
2. After meeting the deductible, the remaining charges are $3,200 - $250 = $2,950.
3. Since the coinsurance rate is 70%, the insurance will cover 70% of $2,950, which is $2,065. The patient is responsible for paying the remaining 30%, which is $2,950 - $2,065 = $885.
4. Now we need to compare the patient's portion ($885) to the annual maximum out-of-pocket amount ($1,000). Since $885 is less than $1,000, the patient will pay the full $885.

Therefore, the total amount the patient owes is $250 (deductible) + $885 (coinsurance) = $1,135.