question archive John plays rugby every weekend
John plays rugby every weekend
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John plays rugby every weekend. During a scrum, John got tangled up awkwardly, fell, and then felt excruciating pain in his rib cage. After everyone separated, it was clear that John suffered multiple compound fractures. Rushed to the nearest hospital by his teammates, John had to undergo emergency surgery to reset the bones and ensure neither of his lungs got punctured. Luckily, John had health insurance. John's health insurance plan had a $164 monthly premium, a $545 deductible, and a $2,535 out-of-pocket maximum. John's copay for emergency room visits was $245 and his coinsurance rate was 80/20, so he paid 20% of the bills after his deductible and copays had been paid. If John's total bill came to $17,020, detail his portion of payments necessary to settle his hospital bill.
Hospital bill subject to insurance benefit --------------
John's share of co-insurance ------------------
John's total responsibility for hospital bill-------------
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Hospital bill subject to insurance benefit = Main bill - deductible = $17020-$545 = $ 16,475
John's share of co-insurance 20%*($ 16,475-$245) = $ 3,246
John's total responsibility for hospital bill= $2,535 (as the maximum out-of-pocket expense is $2,535 and the co-insurance + deductible exceeds the put-of-pocket expense , so maximum liability = $2,535)
