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  • Answer. Calculating OOP Expense

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    Hannah Pascua
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    The document provides examples of calculating patient responsibility amounts for medical orders with varying totals, insurance coverages, deductibles met, and out-of-pocket maximums met. Each example shows the order total, coverage percentage, deductible amount, deductible met, out-of-pocket maximum, out-of-pocket maximum met, and calculated patient responsibility amount. There are 20 such examples presented.

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    Answer. Calculating OOP Expense (1).docx

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    The document provides examples of calculating patient responsibility amounts for medical orders with varying totals, insurance coverages, deductibles met, and out-of-pocket maximums met. Each example shows the order total, coverage percentage, deductible amount, deductible met, out-of-pocket maximum, out-of-pocket maximum met, and calculated patient responsibility amount. There are 20 such examples presented.

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    © All Rights Reserved
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    19 views2 pages

    Answer. Calculating OOP Expense

    Uploaded by

    Hannah Pascua
    The document provides examples of calculating patient responsibility amounts for medical orders with varying totals, insurance coverages, deductibles met, and out-of-pocket maximums met. Each example shows the order total, coverage percentage, deductible amount, deductible met, out-of-pocket maximum, out-of-pocket maximum met, and calculated patient responsibility amount. There are 20 such examples presented.

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    © All Rights Reserved
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    of 2

    Calculating Patient Responsibility

    1. Order Total: $928.20 OOP Met: $0.00


    Coverage: 90%
    Deductible: $600.00 Answer: 599.00
    Deductible Met: $0.00
    OOP: $1,200.00 7. Order Total: $863.00
    OOP Met: $0.00 Coverage: 90%
    Deductible: $2,000.00
    Answer:632.82 Deductible Met: $2,000.00
    OOP: $5,000.00
    2. Order Total: $1,619.10 OOP Met: $4,925.00
    Coverage: 85%
    Deductible: $1,000.00 Answer: 65.00
    Deductible Met: $900.00
    OOP: $2,000.00 8. Order Total: $612.08
    OOP Met: $900.00 Coverage: 90%
    Deductible: $300.00
    Answer: 327.865 Deductible Met: $177.30
    OOP: $1,000.00
    3. Order Total: $460.00 OOP Met: $677.30
    Coverage: 100%
    Copay: $10.00 Answer: 171.64
    OOP: $1,000.00
    OOP Met: $1,000.00 9. Order Total: $311.64
    Coverage: 80%
    Answer: 0.00 Deductible: $2,000.00
    Deductible Met: $0.00
    4. Order Total: $823.00 OOP: $4,000.00
    Coverage: 75% OOP Met: $0.00
    Deductible: $350.00
    Deductible Met: $275.00 Answer: 311.64
    OOP: $2,000.00
    OOP Met: $275.00 10. Order Total: $309.40
    Coverage: 95%
    Answer: 262 Deductible: $1,000.00
    Deductible Met: $1,000.00
    5. Order Total: $3,085.00 OOP: $5,000.00
    Coverage: 50% OOP Met: $5,000.00
    Deductible: $1,000.00
    Deductible Met: $0.00 Answer: 0.00
    OOP: $5,000.00
    OOP Met: $0.00 11. Order Total: $1300.00
    Coverage: 95%
    Answer: 2014.50 Deductible: $3000.00
    Deductible Met: $1500.00
    6. Order Total: $599.00 OOP: $7000.00
    Coverage: 80% OOP Met: $2750.00
    Deductible: $1,000.00
    Deductible Met: $0.00 Answer: 1300.00
    OOP: $2,000.00
    Calculating Patient Responsibility
    12. Order Total: $251.11 Deductible: $800.00
    Coverage: 80% Deductible Met: $250.00
    Deductible: $200.00 OOP: $1800.00
    Deductible Met: $180.00 OOP Met: $1350.00
    OOP: $2000.00
    OOP Met: $1800.00 Answer: 450

    Answer: 66.22 18. Order Total: $875.00


    Coverage: 75%
    13. Order Total: $753.33 Deductible: $900.00
    Coverage: 50% Deductible Met: $835.00
    Deductible: $1500.00 OOP: $2100.00
    Deductible Met: $1230.00 OOP Met: $1890.00
    OOP: $3000.00
    OOP Met: $1230.00 Answer: 210.00

    Answer: 511.67 19. Order Total: $990.00


    Coverage: 85%
    14. Order Total: $1550.00 Deductible: $1300.00
    Coverage: 100% Deductible Met: $975.00
    Copay: $100.00 OOP: $3500.00
    Deductible: $3000.00 OOP Met: $2350.00
    Deductible Met: $2275.00
    OOP: $5000.00 Answer: 424.75
    OOP Met: $3125.00
    20. Order Total: $1100.00
    Answer: 825 Coverage: 95%
    Deductible: $1500.00
    15. Order Total: $900.00 Deductible Met: $50.00
    Coverage: 80% OOP: $3500.00
    Deductible: $1500.00 OOP Met: $50.00
    Deductible Met: $1500.00
    OOP: $3000.00 Answer: 1100.00
    OOP Met: $2750.00

    Answer: 180

    16. Order Total: $680.00


    Coverage: 50%
    Deductible: $300.00
    Deductible Met: $300.00
    OOP: $1500.00
    OOP Met: $1425.00

    Answer: 75

    17. Order Total: $550.00


    Coverage: 75%

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