Employer preferred provider organization plan

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Reference no: EM131138114

Margo, age 35, was severely injured in an auto accident. She is covered under her employer's preferred provider organization (PPO) plan. The plan has a $1000 calendar-year deductible, a 80/20 coinsurance, and an annual out-of-pocket limit of $3,000. As aresult of the accident, Margo incurred the following medical expenses: Cost of ambulance to the hospital $500 Hospital bill for a three-day stay $24,000 Surgery for a broken leg $ 5,000 Prescription drugs outside the hospital $300 Physical therapy for the broken leg $1200 In addition, Margo could not work for one month and lost $4000 in earnings. a. Based on the above, how much will Margo collect for her injury if she receives medical care from health care providers who are part of the PPO network? (Assume that all charges shown are the allowable or approved charges by the insurer and all providers are in the PPO network.) b. Assume that Margo's broken leg does not heal properly, and she needs another surgical operation. Margo would like a different surgeon with an outstanding professional reputation to perform the operation. The surgeon is not a member of the PPO network. Will Margo's plan pay for the surgery? Explain your answer.

Reference no: EM131138114

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Employer preferred provider organization plan : Margo, age 35, was severely injured in an auto accident. She is covered under her employer's preferred provider organization (PPO) plan. The plan has a $1000 calendar-year deductible, a 80/20 coinsurance, and an annual out-of-pocket limit of $3,000.

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