Question

Surgical treatment of a broken arm costs $16,911. You have a $1,000 deductible and then your insurance will pay 85% of the remaining cost. Your insurance also has an out-of-pocket maximum charge of $3,500. What is your cost?

Answer 1

After paying the $1,000 deductible, the insurance covers 85% of the remaining cost. The patient is responsible for the remainder, which totals $3,386.65, a figure that falls under the out-of-pocket maximum of $3,500.

Step-by-step explanation:

First, we calculate the cost after the deductible is applied to the initial cost of the surgical treatment:

• Cost of treatment: $16,911
• Deductible: $1,000
• Remaining cost after deductible: $16,911 - $1,000 = $15,911

Next, we determine how much the insurance will pay and how much remains as the patient's responsibility:

• Insurance coverage: 85% of $15,911 = $13,524.35
• Patient's responsibility after insurance: $15,911 - $13,524.35 = $2,386.65

Finally, we need to consider the out-of-pocket maximum:

• Patient's out-of-pocket maximum: $3,500
• Total cost for the patient (including deductible): $1,000 + $2,386.65 = $3,386.65

Since the total cost for the patient ($3,386.65) is under the out-of-pocket maximum, the patient's cost will be $3,386.65.