To determine how much money a patient will have to pay for a [tex]$\$[/tex]4,300[tex]$ medical bill from an emergency room visit using the given insurance plan, let's break it down step-by-step:
1. Deductible: The deductible is the amount the patient pays out-of-pocket before the insurance covers any expenses. For this plan, the deductible is \$[/tex]2,500.
Since the medical bill (\[tex]$4,300) is greater than the deductible (\$[/tex]2,500), the patient must pay the full deductible.
[tex]\[
\text{Deductible Cost} = \$2,500
\][/tex]
2. Remaining Cost After Deductible: After paying the deductible, we subtract this amount from the total medical bill to find the remaining cost.
[tex]\[
\text{Remaining Cost} = \$4,300 - \$2,500 = \$1,800
\][/tex]
3. Co-insurance: The co-insurance rate is the percentage of the remaining cost that the patient has to pay. For this plan, it is 40%.
To compute the co-insurance cost:
[tex]\[
\text{Co-insurance Cost} = 0.40 \times \$1,800 = \$720.00
\][/tex]
4. Emergency Copay: The insurance plan specifies an emergency copay, which is a fixed amount the patient must pay for an emergency room visit. For this plan, it is \[tex]$500.
\[
\text{Emergency Copay} = \$[/tex]500
\]
5. Total Cost Without Considering Out-of-Pocket Max: Add up the deductible, co-insurance cost, and emergency copay to find the total cost the patient needs to pay without considering the out-of-pocket maximum.
[tex]\[
\text{Total Cost Without Max} = \$2,500 + \$720 + \$500 = \$3,720.00
\][/tex]
6. Out-of-Pocket Maximum: The out-of-pocket maximum is the maximum amount the patient would have to pay in a year for covered medical services. For this plan, it is \[tex]$5,000.
Since the total calculated cost (\$[/tex]3,720) is less than the out-of-pocket maximum (\[tex]$5,000), the patient pays the total calculated cost.
\[
\text{Final Cost to be Paid by the Patient} = \$[/tex]3,720.00
\]
Therefore, the patient will have to pay \[tex]$3,720.00 for a \$[/tex]4,300 medical bill from the emergency room visit.
