Question

Christina Haley of San Marcos, Texas, age 61, recently suffered a severe stroke. She was in intensive care for 12 days and was hospitalized for 18 more days. After being discharged from the hospital, she spent 45 days in a nursing home for medically necessary nursing and rehabilitative care. Christina had a comprehensive health insurance plan through her employer. The policy had a $1,000 deductible, a $50,000 episode limit, and a $250,000 annual limit with an 80/20 coinsurance clause with a $2,000 coinsurance cap. Christina’s policy covered the medically necessary services performed in a nursi

Answer 1

@bibby

Answer 2

@dWillis12

Is this the remainder of the problem statement:

Christina's policy covered the medically necessary services performed in a nursing home setting. Her total bill was $125,765.

(a) How much of Christina's expenses were paid by her insurance policy?
(b) How much did Christina pay?

Answer 3

yes

Answer 4

@dWillis12 Maybe you can define some of these insurance terms.

This work is not mine but that of @PhoneAFriend.
The phoned friend wrote the following:

I hope I understood all that. Insurance costs make my brain melt. It would probably depend on how the insurance defines "episodes" and whether or not they deemed all the charges necessary/reasonable.

I assumed that all charges would be considered reasonable (which is not likely since insurance is evil). And I found her costs for 3 scenarios:

1. Insurance considers everything to be one episode.

2. The hospital = one episode, and rehab=another.

3. ICU, hospital recovery, and rehab are each episodes

See Attachment