The patient is enrolled in a capitated HMO with a $10 copayment for primary care

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Question description

The patient is enrolled in a capitated HMO with a $10 copayment for primary care physican visits and no coinsurance requirements. After collecting $10 from the patient, what amount can the medical insurance specialist bill the payer for an office visit?


I've read all my assigned text, but am not clear on how one would know what the payer would remit for payment as there was no information provided in the text about the terms of the provider's agreement with the payer.

Tutor Answer

(Top Tutor) Daniel C.
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School: UIUC
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