Question

A patient's medical plan includes both in-and out-of-network benefits. The patient has a $25 copay for an in-network provider and 25% coinsurance for an out-of-network provider. The patient needs a service with a $500 fee. How much will the patient pay if seen by an out-of-network provider?

Answer 1

The patient will pay $125 for a $500 service from an out-of-network provider based on the 25% coinsurance rate.

Step-by-step explanation:

To calculate how much a patient will pay for receiving a service from an out-of-network provider with a 25% coinsurance and a service fee of $500, we apply the coinsurance rate to the total fee. The calculation is as follows:

• Identify the total fee for the service: $500.
• Determine the coinsurance rate: 25%.
• Calculate the patient's payment: 25% of $500 = $125.

Therefore, the patient will pay $125 for the service from an out-of-network provider, as opposed to the $25 copay they would have paid for an in-network provider.

Answer 2

The patient with a 25% coinsurance for out-of-network providers would pay $125 for a $500 fee service from an out-of-network provider.

Step-by-step explanation:

When a patient has health insurance that includes both in-and out-of-network benefits, they need to be aware of the different payment structures for services rendered by providers within and outside their insurance network. In this case, a patient needs to pay a 25% coinsurance for out-of-network services. For a service with a $500 fee, this means the patient is responsible for paying 25% of the total cost of the service.

To calculate the amount the patient would pay for an out-of-network provider service, we use the following formula: Coinsurance percentage × Total service fee = Patient's payment.
Therefore: 0.25 × $500 = $125.

Thus, the patient would pay $125 for the $500 service if seen by an out-of-network provider.