Out-of-Pocket Expense
Out-of-Pocket Expense
After attending a family fitness event, Adonis is reminded that he needs to schedule his annual physical. “I really need to ask my doctor about this abdominal pain I’ve been ignoring, too,” he thought. Two weeks later Adonis arrives for his annual physical. At the end of the exam, he mentions the abdominal pain he’s been having. The doctor asks questions and has him complete some additional lab work to check on the issue. Adonis gets notice that the tests come back clear and he’s happy about the good report. He also receives some unwelcome news by mail– he owes $146 for the additional testing his doctor completed! “How did this happen?”, he said to himself. “I really don’t have the extra money to cover this bill and I still don’t know why I’m having abdominal pain”.
Answer the following questions. 1. Which portion of the revenue cycle represents the point at which Adonis is notified about the out-of-pocket expense? 2. If Adonis has an HSA account, how likely is it that he can be reimbursed for paying off the balance? 3. Will switching from a PPO plan to an HMO guarantee that Adonis will not pay for additional testing in the future? Why or why not?