Employer preferred provider organization plan

Assignment Help Operation Management
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

Questions Cloud

Explain the occupational safety : Explain the Occupational Safety and Health Administration’s (OSHA) policy on safety compliance when two or more companies are working at the same facility, such as a subcontractor working for a manufacturing company. What role does the purchasing dep..
Define high-performance work systems : Define high-performance work systems and provide four examples of HR practices that promote this performance.
Failure in offering their products to international market : Identify two US companies that have entered the international arena and report their successes or failure in offering their products to the international market. What financial risks, if any, have they incurred throughout the process?
What is the horizon value : Simonyan Inc. forecasts a free cash flow of $40 million in Year 3, i.e., at t = 3, and it expects FCF to grow at a constant rate of 5% thereafter. If the weighted average cost of capital is 10% and the cost of equity is 15%, what is the horizon value..
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.
Risks from the perspective using the framework : Consider the benefits & risks from the perspective using the framework of the 4P model of key stakeholders: Patients (domestically & internationally) Professionals (domestically & internationally) Payers (public & private) Policymakers (local, state,..
Does the globalization of medicine lessen disparities : Does the globalization of medicine lessen disparities or create more disparities? For who? How can we continue to “level the playing field” for individuals & communities?
What is meant by meta analysis : What is meant by meta analysis? Find an article that has conducted a meta analysis. Send me the link to it. Explain the advantage of having conducted a meta analysis in the study you selected.
Explain why external validity is important : Explain why external validity is important if you are conducting a study on the effectiveness of aspirin in persons who are in the midst of having a stroke. You can give an example to explain the situation. DO NOT define external validity to apply th..

Reviews

Write a Review

Operation Management Questions & Answers

  Book review - the goal

Operations Management is about a book review. Title of the book is "Goal". This book has been written by Dr. Eliyahu Goldartt. The book has been appreciated by many as one of those books which offers an insight into the operations and strategic capac..

  Operational plan in hospitality enterprise

Operational plan pertaining to a hospitality enterprise is given in detail in the solution. The operational plan is an important plan or preparation which gives guidelines regarding the role and responsibilities of each and every operation at all lev..

  Managing operations and information

Recognise the importance of a strategic approach to the development and deployment of organisational information systems. Demonstrate an understanding of the importance of databases and their integration to the organisation's overall information mana..

  A make-or-buy analysis

An analysis of the holding costs, including the appropriate annual holding cost rate.

  Evolution and contributor of operations management

Briefly explain Evolution and contributor of Operations management.

  Functions and responsibilities of an operations manager

A number of drivers of change have transformed the roles, functions and responsibilities of an operations manager over recent years. These drivers have not only been based on technological innovations but also on the need for organisations to develop..

  Compute the optimal order quantity

Compute the Optimal Order quantity of DVD players. Determine the appropriate reorder point.

  Relationship to operations practice in the organisation

Evaluate problems in operations and identify approaches to overcoming them. Critically evaluate operating plans and identify areas for improvement. Justify, implement and evaluate changes to operations in line with modern approaches.

  A make or buy analysis

Develop a report for Figi Fabricating that will address the question of whether the company should continue to purchase the part from the supplier or begin to produce the part itself.

  Prepare a staffing plan

Prepare a staffing plan showing the change of your unit from medical/surgical staffing to oncology staffing.

  Leadership styles in different organizations

Ccompare the effectiveness of different leadership styles in different organizations

  Risk management tools and models

Be able to understand the concept of risk, roles and responsibilities for risk management and risk management tools and models.

Free Assignment Quote

Assured A++ Grade

Get guaranteed satisfaction & time on delivery in every assignment order you paid with us! We ensure premium quality solution document along with free turntin report!

All rights reserved! Copyrights ©2019-2020 ExpertsMind IT Educational Pvt Ltd