Grasp Problem Set 2: #31

[Julietn528]

Can someone tell me why you subtract the reimbursement before you apply the stop loss. I thought that the reimbursement was just in excess of the charge discounted 70%?

[Guy Smiley]

Can someone tell me why you subtract the reimbursement before you apply the stop loss. I thought that the reimbursement was just in excess of the charge discounted 70%?

Who knows, I didn't get that either. As far as I know the syllabus doesn't talk so specifically about this, so I think you'd be fine either way.

[Julietn528]

Who knows, I didn't get that either. As far as I know the syllabus doesn't talk so specifically about this, so I think you'd be fine either way.

Yeah, I decided to skip it, since they don't provide an example in that section and I don't agree with what the solution says. I was thinking about asking my boss what happens in his experience, but I agree that this won't be tested and if they do, they'll be more specific about the reinsurance agreement.

[MarsLasar]

The Stop Loss kicks in after the hospital loses at least $50,000 on an individual admit. This particular set up is not one I've ever seen but the problem makes sense to me.

[Julietn528]

The other issue with this problem is it asks you to calculate revenues. According to notecard, 521, reinsurance recoveries should be calculated as an offset to healthcare costs and not included in revenues. In the problem, the reinsurance is included in the revenues.