Afaf Darcy is insured by an HMO with a R10 copay and out-of-network coinsurance on charge balances of 90-10. She needed physical therapy after her knee replacement. Her HMO pays for eighteen physical therapy sessions in such cases at a rate of $63.50 per visit. If
additional physical therapy is needed, the provider must document the reasons and submit a formal request. The therapist requested
additional visits, and Ms. Darcy attended five additional physical therapy sessions. The request was denied. What amount will the insurance
company pay for her physical therapy? What amount must Ms. Darcy pay? (Hints: You must first deduct $10 from each visit. That is the
patient's copay and must be paid before the insurance share is calculated. Then multiply the charge less S10 (53.50) times the allowed
number of visits (18). Multiply the answer times the insurance company's coinsurance (90%). This is the insurance company's share. For Ms.
Darcy, you will calculate her copay of ($10) times the 18 visits. She must then pay the charge minus 510 [multiply this amount times 18 and
multiply times 10% which is her coinsurance). She must also pay the full amount of the denied visits [$63.50 times 5)