IMG_1272

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School

University of Phoenix *

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Course

202

Subject

Medicine

Date

Apr 3, 2024

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Uploaded by CoachElementWalrus52

) - Health Care. Question 3 5/5 While reviewing a claim form for Tamira Mitchell, you discover the rendering provider is out-of- network with her HMO health care plan. Although she has met her deductible, no referral or authorization was obtained prior to rendering services. The total charges for services rendered are $175. Her benefits are as follows: « HMO medical care for office services * In-network benefits pay at 100% after deductible is met * In-network benefit office copayment: $25 Out-of-network services non-covered without referral or prior authorization Calculate what the patient will owe and the expected reimbursement from the insurance. Show answer choices @ The patient pays $25 and the insurance pays $150. The patient pays zero and the insurance pays $175. @ The patient pays nothing and the insurance pays $200.

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