John Sample
Example #1
John is feeling very sick but cannot get an appointment with his primary care physician, so he goes to a nearby urgent care. The doctor there believes that John has a sinus infection and prescribes him an anti-biotic to treat it. That anti-biotic is a non-speciality generic medication. How much money will John spend on the visit to the doctor and getting his medication?
Example #2
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John falls off of a ladder and is taken to the emergency room by his sister because they fear he broke his arm. He has several x-rays taken (billed at $600). Nothing is broken! But the ER doctor wants him to follow-up with an orthopedic specialist the next week to make sure he is feeling better. How much will John spend on the visit to the ER and the doctor?
These examples will assume that there is a 70/30 co-insurance (meaning the insurance company pays 70% of the service cost and the patient pays 30%) The three Rx (prescription) co-pays are for generic non-speciality drugs ($25), generic speciality drugs ($45) and brand name drugs ($75)
John Sample
Example #1
John is feeling very sick but cannot get an appointment with his primary care physician, so he goes to a nearby urgent care. The doctor there believes that John has a sinus infection and prescribes him an anti-biotic to treat it. That anti-biotic is a non-speciality generic medication. How much money will John spend on the visit to the doctor and getting his medication?
Solution
Urgent care co-pay: $75 Prescription cost: $25 Total cost: $100
These examples will assume that there is a 70/30 co-insurance (meaning the insurance company pays 70% of the service cost and the patient pays 30%) The three Rx (prescription) co-pays are for generic non-speciality drugs ($25), generic speciality drugs ($45) and brand name drugs ($75)
John Sample
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Example #2
John falls off of a ladder and is taken to the emergency room by his sister because they fear he broke his arm. He has several x-rays taken (billed at $600). Nothing is broken! But the ER doctor wants him to follow-up with his primary care physician the next week to make sure he is feeling better. How much will John spend on the visit to the ER and his doctor?
Solution
ER co-pay: $150 X-ray cost to cover deductible :$500 X-ray co-insurance cost (30% of remaining $100): $30 Visit to Doctor: $30 Total: $710
These examples will assume that there is a 70/30 co-insurance (meaning the insurance company pays 70% of the service cost and the patient pays 30%) The three Rx (prescription) co-pays are for generic non-speciality drugs ($25), generic speciality drugs ($45) and brand name drugs ($75)