You are analyst with Lifetime HMO, and you were asked to perform an analysis of services for services provided in January 2021. The HMO has a point-of-service (POS) option for its members but will pay only 50% of approved charges. If a member goes out of network for a medical procedure with a charge of $4,000, of which $2,800 is approved. The HMO will pay 100% of charges for in network charges at its hospitals. The agreed upon in network charges are $3,000. For the month of January 20X1, twenty patients elected to have a medical procedure. Ten of the patients were out of network. And ten of the patients were in network. What is the amount of total monetary payment for both out-of-network, and in-network the insurance company is obligated to pay for services rendered. Please show your work.
You are analyst with Lifetime HMO, and you were asked to perform an analysis of services for services provided in January 2021. The HMO has a point-of-service (POS) option for its members but will pay only 50% of approved charges. If a member goes out of network for a medical procedure with a charge of $4,000, of which $2,800 is approved. The HMO will pay 100% of charges for in network charges at its hospitals. The agreed upon in network charges are $3,000. For the month of January 20X1, twenty patients elected to have a medical procedure. Ten of the patients were out of network. And ten of the patients were in network.
What is the amount of total monetary payment for both out-of-network, and in-network the insurance company is obligated to pay for services rendered. Please show your work.
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