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This analysis compares the out-of-pocket medical expenses incurred by two employees, Sandy and Sam, under the BCBS medical plan with employee-only coverage. Sandy has routine medical needs, including office visits, a physical exam, and lab work, totaling $1,205. In contrast, Sam experiences a serious knee injury requiring extensive treatment, including specialist visits, surgery, and physical therapy, leading to costs of $4,770. Understanding these expenses helps illustrate the financial impact of different medical needs on insurance coverage.
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Sandy has employee-only coverage under the BCBS medical plan. During the year, she has four office visits ($120 each), an annual physical exam ($160), and an annual well woman exam ($85). She also has some lab work done ($210) and has several prescriptions filled ($600). Let’s see how her out-of-pocket cost compare.
Sam has employee-only coverage under the BCBS medical plan. During the year, he has a bicycling accident that results in a knee injury. In addition to his annual physical exam ($160) at the beginning of the year, he has three visits to a sports medicine specialist ($310 each), received prescription drugs ($130 each) for the pain, and has X-rays and lab tests ($400) as well as inpatient arthoscopic surgery ($3000) on his knee. After surgery, he has eight sessions of physical therapy ($704). All of Sam’s expenses are allowable medical expenses. Let’s see how his out-of-pocket cost compare.
