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Jane did not feel well during the week end with a mild chest pain. She went to the emergency service of a public hospital. The triage nurse decided that it was serious enough to admit Jane for a series of tests, conducted by cardiologists. Jane undertook a Transthoracic Echocardiogram.(a)    Jane decided to be admitted as a public patient. By searching MBS site, provide the MBS fee and the benefit Medicare provided for her Transthoracic Echocardiogram. Provide the web address where you find the information. Conclude about Jane's out-of-pocket cost. Explain your reasoning in detail.(1.5 mark)(b)     She decided to be admitted as a private patient in the public hospital using her private health insurance.  The Transthoracic Echocardiogram was billed by the cardiologist at $300 and this particular service turned out not to be covered by her private insurance at all.  Calculate the out-of-pocket cost that she incurred for the Transthoracic Echocardiogram. Explain your reasoning in detail.(1.5 mark)Write your answers in the answer box below. Give the details of your calculations and justify any choice you make.

Question

Jane did not feel well during the week end with a mild chest pain. She went to the emergency service of a public hospital. The triage nurse decided that it was serious enough to admit Jane for a series of tests, conducted by cardiologists. Jane undertook a Transthoracic Echocardiogram.(a)    Jane decided to be admitted as a public patient. By searching MBS site, provide the MBS fee and the benefit Medicare provided for her Transthoracic Echocardiogram. Provide the web address where you find the information. Conclude about Jane's out-of-pocket cost. Explain your reasoning in detail.(1.5 mark)(b)     She decided to be admitted as a private patient in the public hospital using her private health insurance.  The Transthoracic Echocardiogram was billed by the cardiologist at $300 and this particular service turned out not to be covered by her private insurance at all.  Calculate the out-of-pocket cost that she incurred for the Transthoracic Echocardiogram. Explain your reasoning in detail.(1.5 mark)Write your answers in the answer box below. Give the details of your calculations and justify any choice you make.

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Solution

(a) To find the MBS fee and the benefit Medicare provided for Jane's Transthoracic Echocardiogram, you would need to visit the MBS Online website (http://www.mbsonline.gov.au). Once there, you can search for the specific item number for a Transthoracic Echocardiogram, which is 55136. According to the MBS Online, the MBS fee for this procedure is 102.30andtheMedicarebenefitis75102.30 and the Medicare benefit is 75% of the MBS fee for in-hospital services, which would be 76.73. As a public patient, Jane would not have any out-of-pocket costs because the public hospital covers the cost of the procedure and Medicare covers the remaining amount.

(b) As a private patient in a public hospital, Jane's Transthoracic Echocardiogram was billed at 300bythecardiologist.Sincethisservicewasnotcoveredbyherprivateinsurance,Janewouldberesponsiblefortheentirecost.However,shecanstillclaimtheMedicarebenefitof300 by the cardiologist. Since this service was not covered by her private insurance, Jane would be responsible for the entire cost. However, she can still claim the Medicare benefit of 76.73 (75% of the MBS fee). Therefore, her out-of-pocket cost would be the billed amount minus the Medicare benefit, which is 300300 - 76.73 = $223.27.

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Rodney, 16 year old,  was admitted in the emergency service of a private hospital as a private patient after he broke his foot. He had several Xrays while at hospital. He now needs to have Xrays every month to check the progress of the healing. His parents have a private hospital cover with no excess.A.Radiologist fees in hospital are covered for 85% of MBS by Medicare; the private insurance is providing a supplement;  the fees in the monthly appointments are only covered by Medicare for 75% of the MBS fee.B.Radiologists fees in hospital were entirely covered by the private insurance but the fees in the monthly appointments are covered by Medicare for 100% of the MBS fee.C.Radiologists fees in hospital and for the monthly appointments are entirely covered by Medicare and the private insurance.D.Radiologist fees in hospital are covered for 75% of MBS by Medicare; the private insurance is providing a supplement;  the fees in the monthly appointments are only covered by Medicare for 85% of the MBS fee.E.Radiologist fees in hospital are covered for 75% of MBS by Medicare; the private insurance is providing a supplement;  the fees in the monthly appointments are only covered by Medicare for 100% of the MBS fee.

Rodney, 16 year old,  was admitted in the emergency service of a private hospital as a private patient after he broke his foot. He had several Xrays while at hospital. He now needs to have Xrays every month to check the progress of the healing. His parents have a private hospital cover with no excess.A.Radiologist fees in hospital are covered for 75% of MBS by Medicare; the private insurance is providing a supplement;  the fees in the monthly appointments are only covered by Medicare for 85% of the MBS fee.B.Radiologists fees in hospital and for the monthly appointments are entirely covered by Medicare and the private insurance.C.Radiologists fees in hospital were entirely covered by the private insurance but the fees in the monthly appointments are covered by Medicare for 100% of the MBS fee.D.Radiologist fees in hospital are covered for 75% of MBS by Medicare; the private insurance is providing a supplement;  the fees in the monthly appointments are only covered by Medicare for 100% of the MBS fee.E.Radiologist fees in hospital are covered for 85% of MBS by Medicare; the private insurance is providing a supplement;  the fees in the monthly appointments are only covered by Medicare for 75% of the MBS fee.

Rodney, 16 year old,  was admitted in the emergency service of a private hospital as a private patient after he broke his foot. He had several Xrays while at hospital. He now needs to have Xrays every month to check the progress of the healing. His parents have a private hospital cover with no excess.A.Radiologists fees in hospital were entirely covered by the private insurance but the fees in the monthly appointments are covered by Medicare for 100% of the MBS fee.B.Radiologist fees in hospital are covered for 85% of MBS by Medicare; the private insurance is providing a supplement;  the fees in the monthly appointments are only covered by Medicare for 75% of the MBS fee.C.Radiologist fees in hospital are covered for 75% of MBS by Medicare; the private insurance is providing a supplement;  the fees in the monthly appointments are only covered by Medicare for 85% of the MBS fee.D.Radiologists fees in hospital and for the monthly appointments are entirely covered by Medicare and the private insurance.E.Radiologist fees in hospital are covered for 75% of MBS by Medicare; the private insurance is providing a supplement;  the fees in the monthly appointments are only covered by Medicare for 100% of the MBS fee.

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