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Laura was billed $1200 for a recent surgery. The patient has a $1500 deductible of which she has met $800. In addition, her policy has 10% coinsurance. How much will insurance pay? How much will laura pay? 

1 Answer

7 votes

Answer:

  • insurance: $380
  • Laura: $820

Explanation:

You want to know who pays what when Laura is billed $1200, her coinsurance is 10%, and she has met $800 of a $1500 deductible.

Coinsurance

The coinsurance Laura must pay is 10% of the amount of the bill in addition to any remaining deductible. Laura's coinsurance is ...

10% × $1200 = $120

Deductible

The amount of the bill exceeds Laura's remaining deductible, so she must also pay the full amount of that. The remaining deductible Laura must pay is $1500 -800 = $700.

Laura's cost

The total amount Laura must pay on this bill is ...

$120 +700 = $820 . . . . Laura pays

Insurance

The insurance policy will pay the remaining amount of the bill:

$1200 -820 = $380

= 90% × $1200 -700 = $1080 -700 = $380 . . . . insurance pays

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Additional comment

The coinsurance amount, and the sum of all payments, is based on the price of the procedure negotiated between the provider and the insurance company. This may differ substantially from the amount billed for the procedure.

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User Yonatan Wilkof
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