Excellent Health Plan Member Name: Veronica Casto Member ID:…

Questions

Excellent Heаlth Plаn Member Nаme: Verоnica Castо Member ID: MKJ538721P   Prescriptiоn Group No: W32187 RX Group: 321543   Generic RX $15 Preferred Name brand RX $50 Nonpreferred Name brand RX $70 Unknown State University Prime Care Excellence – HMO   Date Issued 04/01/XXXX   In-Network Member Responsibility Primary               $25.00 Specialist            $50.00 PT/OT/SP           $35.00 BH, SU               $100.00 Urgent Care        $50.00 ED                      $150.00   Veronica had bronchitis for the past eight days.  Feeling miserable, she went to the local hospital’s Emergency Department for care. She received a prescription for antibiotics.  What co-payment should the hospital collect?

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