1. Peace of Mind Insurance can give you financial security and peace of mind, especially in case of unexpected expenses. When do people use insurance?

2. Lesson Objective Calculate the amount the patient pays for health care. Content Vocabulary deductible The amount of money you must pay each year before your insurance company starts paying. co-insurance co-payment co-insurance Requires you to pay either a set amount or a certain percent of medical expenses. co-payment A predetermined flat fee you pay for health care services.

4. Brooke Kolodie is single and has a health insurance plan with the benefits shown in Figure 11.1 on page 421 or your textbook. Her recent network health costs include co- payments for 8 physician visits and 9 specialist visits. Example 1

5. Following hospital surgery, she made co- payments for 12 physical therapy visits at $85 each and she had co-payments at her local pharmacy for 3 generic drugs and 1 brand name drug. The hospital admission charge was $200, and her hospital bill was $34,560. What amount did she pay? Example 1 (cont.)

6. Find the deductible. The deductible is $1000. Example 1 Answer: Step 1

7. Find the cost of the co-payments. Physician + Specialists + Physical Therapy +Pharmacy ($20 × 8) + ($30 × 9) + ($85 × 20% x 12) + 3(10)+20 = $160 + $270 + $204 + $50 = $684 Example 1 Answer: Step 2

8. Find the co-insurance amount for home health care. (Note: Co-insurance requires the insurance company to pay 80 percent of the costs and the patient pays 20 percent of the costs.) $55 × (75 – 50) × 20% $55 × 25 × 20% = $275 Example 1 Answer: Step 3

9. Find the hospital charges. (Note: The patient pays a small percent of the hospital charge, such as 10 percent.) $34,560 × (100% – 90%) + 200 $34,560 × 10% + $200= $3656 Example 1 Answer: Step 4

10. Find the amount paid by patient. Deductible + Co-payment + Co-insurance + Hospital Amount Charges $100 + $684 + $3656 = $5340 Example 1 Answer: Step 5

11. Refer to Figure 11.1 on page 421 of your textbook. Leonard Smalls Family plan, Non-network Co-payments: 22 physician visits;12 specialist visits; 25 physical therapy visits at $55 each; 1 ER visit; hospital charge of $15,600 Find the deductible, co-payment, co-insurance, hospital charges, and total paid by the patient. Practice 1

12. Deductible: $4,500 Co-payment: 22(30) + 12(40) +100 = $1240 Hospital co-insurance: 15600(.3) = $4,680 Co-insurance: 25(55)(.3) = $412.50 Total paid: $10,832.50 Practice 1 Answer