HI 00610.490 Noninpatient Psychiatric Services Limitation Computation

To compute the benefit:

1. A. 

   Consider all noninpatient psychiatric reasonable charges up to a maximum of $500, whether or not applied to the deductible.

2. B. 

   Multiply by .625.

3. C. 

   Subtract any unsatisfied deductible.

4. D. 

   Multiply by 8.

Example

In 1982, a patient had psychiatric treatment while not an inpatient and incurred total reasonable charges of $600. The benefit payable is computed as follows: $500 (maximum charges allowable) ×.625=$312.50. Since no part of the deductible has been satisfied for the year, subtract $75, leaving $237.50. The benefit payable is $190 (80 percent of $237.50).