How to Answer Chapter Insurance Assignment Questions (Complete Guide)

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This topic involves chapter insurance assignment. A strong answer should include explanation, application, and examples.

Original Question

Chapter 2 Insurance Assignment Instructions – read each question carefully and type your answers directly on this paper and submit to Canvas. You will add your name at the end of the assignment. 1. Summary of Benefits and Coverage (Level 2—Understanding) (20 pts – 2 pts each) 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 What is the cost-sharing for outpatient surgery provided at a network- $100 facility? What is the cost-sharing for a tier 2 drug purchased at an out-of- network pharmacy?- $40 What is the cost-sharing for a specialty drug, network provider?- $50 What is the cost-sharing for a network immunization visit? No Charge What is the cost-sharing for a network specialist visit?$50 What is the cost-sharing amount for the surgeon fees for outpatient- $40 surgery provided at an out-of-network facility? What is the cost-sharing for a generic drug, network provider? $10 What is the cost-sharing for an out-of-network primary care visit? $40 What is the cost-sharing for x-rays provided by a network provider?$10 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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