Get Answer: Figure Cost Sharing Question Guide

Students often encounter this when studying fundamental concepts.

What This Question Is About

This question relates to figure cost sharing and requires a structured academic response.

How to Approach This Question

Structure your response with introduction, analysis, and conclusion.

Key Explanation

This topic involves figure cost sharing. A strong answer should include explanation, application, and examples.

Original Question

Use figure 2.1 (Cost-sharing – sample from a Benefits and Coverage Summary) from the textbook to identify the cost-sharing components. Complete the accompanying table. Question Answer What is the cost-sharing for a network primary care visit $35 copay/office visit and $20 coinsurance for outpatient services What is the cost-sharing for outpatient surgery provided at a network facility? $100/day copay $20 coinsurance $50 coinsurance for anesthesia What is the cost-sharing for a tier 2 drug purchased at an out-of- network pharmacy? 40% coinsurance What is the cost-sharing for a specialty drug, network provider? 50% coinsurance What is the cost-sharing for a network immunization visit? No charge What is the cost-sharing for a network specialist visit? $50 copay/test What is the cost-sharing amount for the surgeon fees for outpatient surgery provided at an out-of-network facility? $40 coinsurance What is the cost-sharing for a generic drug, network provider? $!0 copay/prescription What is the cost-sharing for an out-of-network primary care visit? $40 coinsurance What is the cost-sharing for x-rays provided by a network provider? $10 copay/test 2. Intermediate Exercises Cost-Sharing Expense (Level 3—Applying) Calculate the cost-sharing amount for the scenarios below (the first one is done for you as an example). The total reimbursement amount that will be paid to the provider is listed. Using the cost-sharing parameters as outlined in figure 2.1 in your book (and that you have filled in above) cost sharing provision section of a sample Summary of Benefits and Coverage, determine how much of the total reimbursement will be paid by the beneficiary, (you can assume that All deductibles have been satisfied. EXAMPLE: Primary care visit with Dr. King for a sinus infection, Dr. King is an out- of- network provider. The patient was examined, x-rays were taken, a nasal swab was taken and sent to the hospital laboratory, and a diagnosis was made. The amount billed for Dr. King’s portion of the encounter is $135.00. Visit DOS: 12/15/22 Based on the information given in Figure 2.1, how much money was Dr. King reimbursed for his portion of the services? Total reimbursement to Dr. King = $81.00 Feedback: 40% of 135.00 is 54.00, thus the patient must pay $54.00. ___________________________________________________________________ Now it’s your turn #1: Outpatient Surgery Visit Community Hospital (in-network) DOS: 10/15/22 – 10/15/22 Total reimbursement to Community Hospital: $5,330 Cost-sharing amount is ______________ (3 points) Your Turn #2 Endocrinologist visit, in-network Encounter at Dr. Carsons’ office Visit DOS: 11/5/22 Total reimbursement to Dr. Carson: ___________ Cost-sharing amount is ________________ (3 points) Your turn #3 Pharmacy prescription, network provider, the Rx is a specialty drug at Martin’s Food Store Pharmacy Date prescription filled: 10/04/2022 Pharmacy charged: $452.00 Total reimbursement by the insurance: $226 Cost-sharing amount is __

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