Your classmate recently had his gallbladder removed. His total bill for this surgery, which was his only healthcare expense for the year, came to $13,820. His health insurance plan has a $400 annual deductible and an 80/20 coinsurance provision. The cap on his coinsurance share is $1,920. How much of the bill will your classmate pay?
Answer (1)
To determine how much your classmate will pay for the gallbladder removal surgery, we'll break down the costs and apply the insurance plan's rules.
Annual Deductible : The deductible is the initial part of the medical expenses that the patient must pay before the insurance starts contributing. Here, the deductible is $400.
Coinsurance : After the deductible has been paid, the remaining hospital bill is partially covered by the insurance company and partially by the insured, at an 80/20 split, meaning 80% will be covered by the insurance company, and 20% will be paid by the patient. However, the patient's share of coinsurance costs is capped at $1,920.
Total Bill : $13,820
Paying the Deductible First : $13,820 - $400 = $13,420
Calculating the Coinsurance Amount :
Patient's Share (20% of the remaining bill): 0.20 × 13 , 420 = 2 , 684
However, the coinsurance cap limits this amount to $1,920. So, the patient will actually pay $1,920.
Total out-of-pocket expenses = Deductible + Coinsurance Share
= $400 (Deductible) + $1,920 (Coinsurance)
Total Patient Cost : $400 + $1,920 = $2,320
So, your classmate will pay a total of $2,320 for his gallbladder surgery out of the $13,820 bill.
