What is the adjusted Premium calculation formula for insurance?

Answer 1

For health insurance: Total Charge = Insurance Payment + Insurance Adjustment + Self Pay (+Non-covered) Total Charge = Insurance Payment + Insurance Adjustment + Deductable + Coinsurance + Non covered charges Total Charge= INS + CJR + Deductible + Co +NC EXAMPLE: The Patient is seen for an MRI costing $3500, where the insurace states covered charges are $3000. They are on a 90/10 plan ( based on total charges) with a $500 unmet deductable. Find the following a. Insurace Payment 2150 3500-500-850= 2150 b. Insurance Adjustment 500 3500-3000= 500 c. Patient Responsibility 850 500 + 350 (10% of total 3500) = 850 ----------------------------------------------------------------------------------------------------------- THE EASYER WAY IS: 1st figure the Insurarace Adjustment 500 3500-3000=500 2nd the Patient Responsibily 850 500 + 350 (10% of total 3500) = 850 3rd Insurance Payment 2150 3500-500-850= 2150