How to Answer Using Cost Sharing Questions (Complete Guide)
This question focuses on applying theory to practical scenarios.
What This Question Is About
This question relates to using cost sharing and requires a structured academic response.
How to Approach This Question
Focus on explaining concepts clearly and supporting them with examples.
Key Explanation
This topic involves using cost sharing. A strong answer should include explanation, application, and examples.
Original Question
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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