Final answer:
The patient's claim payment under a Basic hospital/surgical expense policy is based on deductibles, co-insurance or co-payments, and it may also be influenced by whether the policy operates on a fee-for-service basis or through an HMO.
Step-by-step explanation:
Under a Basic hospital/surgical expense policy, the amount of the patient's claim payment will generally be based on several factors. These include the deductible, which is the amount that the insurance policyholders must pay out of their own pocket before the insurance coverage starts paying. Once the deductible is met, the payment might also be affected by any required co-insurance or co-payment amounts. Co-insurance is a percentage of the medical costs that the insured is responsible for paying, while a co-payment is a fixed amount that the insured must pay for specific services, like a doctor's visit or an emergency room visit.
Moreover, a fee-for-service system may come into play, in which the medical care providers are reimbursed according to the cost of the services they provide. Alternatively, under a health maintenance organization (HMO), providers are paid a fixed amount per person enrolled, regardless of how many services those insured individuals receive.