Question

A perez was seen in your office twice last fall. her deductible has been met and her coinsurance is 85-15. in october, she was seen for influenza vaccination, and her insurance company was billed 13.00 for the vaccine and9.00 for the administration of the vaccine. lisa's schedule of benefits for her indemnity insurance plan lists the influenza administration as being a covered service, but it does not include the actual vaccine. in december, lisa had an office visit and had blood drawn to be sent to an outside lab; both these services are included in the schedule of benefits. the ledger card or patient statement shows the dates and charges for services; you need to calculate each amount paid by the insurance plan and enter it on the ledger card or patient statement. remember to keep a running balance.

Answer 1

In this scenario, Lisa has a deductible that has been met and a coinsurance rate of 85-15. The deductible is the amount that Lisa must pay out of pocket before her insurance coverage kicks in. The coinsurance rate means that Lisa is responsible for paying 15% of the costs, while the insurance company will cover the remaining 85%.

Step-by-step explanation:

In this scenario, Lisa has a deductible that has been met and a coinsurance rate of 85-15. The deductible is the amount that Lisa must pay out of pocket before her insurance coverage kicks in. The coinsurance rate means that Lisa is responsible for paying 15% of the costs, while the insurance company will cover the remaining 85%.

In October, Lisa received an influenza vaccination, which was billed at $13.00 for the vaccine and $9.00 for the administration of the vaccine. Since the administration of the vaccine is listed as a covered service in her insurance plan, her insurance company will cover 85% of the $9.00 administration fee, which is $7.65. Therefore, Lisa will be responsible for paying the remaining 15% of the administration fee, which is $1.35. Since the actual vaccine is not covered in her plan, she will be responsible for paying the full $13.00.

In December, Lisa had an office visit and had blood drawn to be sent to an outside lab. Both of these services are included in her insurance plan's schedule of benefits. The charges for these services are not provided in the question, so it is not possible to calculate the amounts paid by the insurance plan or the running balance.