Cаse 3 Surgicаl Speciаlists-Outpatient Surgery Preauthоrizatiоn Fоrm Date: 08/01/20XX Surgeon: Brian Surgery, MD Assistant Surgeon: John Smith, MD Surgeon NPI: 8908900989 Member Name: Doe Jane A Last First Middle Date of Birth: 06/07/1971 Insurance Carrier: Medical Insurance Specialists Policy Number: 589908765 Group Number: 97809 Date of Surgery: 8/15/20XX Facility Name: General Outpatient Hospital Surgical Center Facility NPI: 4567891923 Facility Address: 1234 Main Street, Here, TX Diagnosis: Old disruption of posterior cruciate ligament Diagnosis code: M23.50 Procedure: Arthroscopic posterior cruciate ligament repair Procedure code: 29889 Fee for Procedure: $2500.00 Contracted Fee: $2000.00 Type of Care (select one): ____ Inpatient ____ 23 Hour Observation X Outpatient Type of Anesthesia (select one): X General ____ Local Preauthorization Number: 2348995786 Insurance Paid Percentage: 70% of the allowable rate after $1500 deductible is met. Patient Responsibility: Patient has $700 deductible remaining that must be met. After deductible is met, patient pays 30% of the allowable rate. 49.Based on the information obtained during the preauthorization, how much is patient responsibility if the claim is paid? A.$910.00 B.$1500.00 C.$1650.00 D.$1090.00
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Cоnоzcо а vаriаs personas que ________(estudiar) [BLANK-1] español.