While reviewing a claim form for Juan Michaels, you discover the rendering provider is out-of-network with his PPO health care plan. Juan has met his deductible and the total charges for services rendered are $350. The plan pays the usual and customary fee rates, which matches the amount billed. His benefits are as follows:
- PPO medical care for office services
- In-network benefit office copayment: $25.
- Out-of-network benefit and coinsurance: 20% of allowed amount.
Calculate what the patient will owe and the expected reimbursement from the insurance.
a. The patient pays the full $350 and the insurance pays zero.
b. The patient pays $70 and the insurance pays $280.
c. The patient pays nothing and the insurance pays $350.
d. The patient pays $25 and the insurance pays $325.
