Grayson, D. HI215 Unit 4 Assisnment.docx - RUNNING HEAD Insurance Plan Review HI215 Reimbursement Methodologies Denise Grayson Professor R Mainard

Grayson, D. HI215 Unit 4 Assisnment.docx - RUNNING HEAD...

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RUNNING HEAD: Insurance Plan Review 1. HI215 Reimbursement Methodologies Denise Grayson Professor R. Mainard Tuesday, September 17, 2019
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RUNNING HEAD: Insurance Plan Review 2. 1. Insurance Plan Review: a. What is the difference between the out-of-pocket limits for participating providers per person and per family versus non-participating providers per person per family ? The out-of-pocket limits for participating provider are $2,500.00 (per person) and $5,000.00 (family), and for non-participating providers $4,000.00 (per person) and $8,000.00 (family). b. What are the copay/coinsurance costs for the various levels (tiers) of prescription drugs available with the plan? Are there are limitations & exceptions? For retail prescriptions a 30-day supply of generic prescription medications copay is $10.00, for supplies of 31-90 days the cost is the same but by per mail order only. The brand name cost is a 20% copay with no limitations while the non-preferred brand prescriptions the cost is a 40% copay with no restrictions. Specialty prescriptions carry a 50% copay but have no restrictions. c. In the coverage example on Managing Type 2 Diabetes, what is the listed total out of pocket costs for the patient assuming they are participating wellness program? Does participating in a diabetes wellness program make any difference? With the participation of a diabetes wellness program, the patient overall out-of-pocket cost is reduced to about $1,880.00, if the patient was not in the wellness program the cost would be much higher.
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