To determine how much a patient will have to pay for a \[tex]$4,500 medical bill from an emergency room visit under this insurance plan, we need to consider the deductible, co-insurance, emergency copay, and the out-of-pocket maximum. Here are the detailed steps:
1. Initial Variables:
- Medical Bill: \$[/tex]4,500
- Deductible: \[tex]$2,500
- Co-insurance Rate: 40% (0.40)
- Emergency Copay: \$[/tex]400
- Out-of-Pocket Maximum: \[tex]$5,000
2. Step 1: Apply Deductible
- The deductible is the amount the patient must pay out of pocket before the insurance starts to cover costs.
- So, the patient first pays the deductible amount of \$[/tex]2,500.
- Remaining bill after deductible: \[tex]$4,500 - \$[/tex]2,500 = \[tex]$2,000
3. Step 2: Apply Co-insurance
- Co-insurance is the percentage of the remaining bill that the patient has to pay after the deductible has been met.
- Co-insurance Amount: 40% of \$[/tex]2,000 = 0.40 * \[tex]$2,000 = \$[/tex]800
4. Step 3: Add Emergency Copay
- The emergency copay is an additional fixed amount the patient must pay for the emergency room visit.
- Emergency Copay: \[tex]$400
5. Step 4: Calculate Total Cost to Patient
- Total cost (before considering out-of-pocket max) is the sum of the deductible, co-insurance amount, and emergency copay:
- Total Cost: \$[/tex]2,500 (deductible) + \[tex]$800 (co-insurance) + \$[/tex]400 (emergency copay) = \[tex]$3,700
6. Step 5: Check Against Out-of-Pocket Maximum
- The out-of-pocket maximum is the upper limit the patient has to pay in a given year for covered services.
- In this case, the calculated total cost (\$[/tex]3,700) does not exceed the out-of-pocket maximum of \[tex]$5,000.
Thus, the total amount the patient will have to pay for the \$[/tex]4,500 medical bill from an emergency room visit is \$3,700.
