Patient Stan Lee has PPO healthcare insurance. He goes to a preferred provider dermatologist for removal of a small skin lesion. The insurer has agreed to pay its preferred providers $90 for this service. (The dermatologist's full charge for the service is $120.) The insurer pays only $20 because the policy requires a $20 patient co-payment and a $100 annual deductible. Prior to this service, Stan Lee had paid $50 of the deductible. Why can the dermatologist not bill Mr. Lee $100?
What will be an ideal response?
The dermatologist has a contractual agreement with the PPO insurer to charge only $90 for the service. Since the insurer paid $20, the dermatologist can only bill the patient $70: the $20 co-payment and the $50 remaining of the patient's annual deductible amount.
You might also like to view...
What are the typical time frames for adopting a social ecological model??
A) almost immediate B) short-term C) medium-term D) long-term
An air embolus in the right atrium is corrected by placing the patient in the right lateral position
Indicate whether the statement is true or false.
In the physical examination of urine, all of the following are true EXCEPT:
A. the color is recorded B. the pH is measured C. transparency is noted D. specific gravity is measured
You need to indicate in Medisoft that a patient is an Active member of the armed forces. Where would you make this distinction?
A. the Policy 2 tab B. the Sponsor Status box C. the Policy 3 tab D. the Branch of Service box of the Medicaid and Tricare tab