Question

Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit that included a number of services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him?

Answer 1

Answer:

What you could tell him is that you can offer to help him review all the plans appeal process as well as to help him ask the plan to review his coverage decision which will enable him to know why he had large charges in excess of his maximum out-of-pocket limit.

Explanation:

Based on the information given we were told that when he received the bill, their was large charges in excess of his maximum out-of-pocket limit which is a limit on the amount of money a person or an individual have to pay for covered medical care services in which we were still told that the large charges in excess of his maximum out-of-pocket limit also include a number of services and items he thought would be fully covered, therefore since he called you to ask what he could do, What you could tell him is that you will offer to help him review all the plans appeal process and to as well help him to ask the plan to review the coverage decision which is why coverage decision is of benefit because it enables a person or an individual to makes decision about their benefits including the amount they have to pay for their medical services plan.