| Course | HCA 110 Insurance and Healthcare Reimbursement |
|---|---|
| Module | Module 2 |
| Paper type | Benefits verification paper |
| Length | About 1,050 words, 6 pages |
| Format | APA 7 student paper |
| School | Aspen University |
| Program | Health Care Administration |
| Updated | September 2026 |
Free sample paper for HCA 110 Module 2
What Will This Cost Me? Verifying Benefits and Estimating a Patient's Share Before an MRI
Student Name
Health Care Administration Program, Aspen University
HCA 110: Insurance and Healthcare Reimbursement
Instructor Name
Month Day, Year
What Will This Cost Me? Verifying Benefits and Estimating a Patient's Share Before an MRI
Patients increasingly ask what a service will cost before they agree to it, and practices increasingly need to know before the visit whether they will be paid. Benefits verification answers both questions. It confirms that the patient's coverage is active, that the provider is in network, what the plan requires before the service and how much the patient will owe. This paper works through a verification and cost estimate for one composite patient scheduled for a knee MRI and an orthopedic visit.
The Case
Ms. T., a composite 44-year-old teacher, is referred by her primary care physician to an orthopedic practice for persistent knee pain, and the orthopedist plans an MRI at the practice's imaging center. She has a preferred provider plan through her school district. The billing specialist has three business days before the visit to verify her benefits and give her an estimate.
Step One: Eligibility
The specialist first checks eligibility electronically through the payer portal using the member ID, name and date of birth from the card. The response confirms that coverage is active for the date of service and names the plan. A common error is checking only that the patient has coverage today, not on the planned date; a patient who changes jobs at month's end may lose coverage before the visit.
Step Two: Network Status
Next, the specialist confirms that both the orthopedist and the imaging center are in network for this specific plan. A provider may be in network for one product from a payer and out of network for another from the same payer. Out-of-network care would raise Ms. T.'s share sharply, so this check matters as much as eligibility.
Step Three: Benefit Details
The specialist records the benefit details for the two services. The table summarizes what the portal and a call to the plan confirmed.
| Benefit item | Ms. T.'s plan (composite) |
|---|---|
| Deductible (individual) | $2,000; $1,650 already met this year |
| Specialist visit | $50 copay, not subject to deductible |
| Advanced imaging (MRI) | 20% coinsurance after deductible |
| Out-of-pocket maximum | $5,000; $2,100 spent so far |
| Prior authorization | Required for MRI |
| Referral | Not required under this PPO |
Step Four: Prior Authorization
The plan requires prior authorization for the MRI. The specialist submits the request with the orthopedist's notes on symptoms, exam findings and failed conservative treatment. Prior authorization is meant to control unnecessary use, but it can delay care. A systematic review of studies on health plan prior authorization found evidence of adverse effects on clinical effectiveness and patient outcomes, including delays in treatment (Murphy et al., 2026). The billing office can reduce harm by submitting complete requests quickly and tracking them daily.
Step Five: The Arithmetic
The plan's allowed amount for the MRI at this imaging center is $1,100. Ms. T. still owes $350 of her deductible, so she pays the first $350. The remaining $750 is split, with Ms. T. paying 20% coinsurance, $150, and the plan paying $600. Her share of the MRI is $500. The specialist visit adds a $50 copay. Her total estimate is $550, well under the remaining $2,900 before her out-of-pocket maximum.
Writing the Estimate
The estimate given to Ms. T. lists each service, the allowed amount, what her plan is expected to pay and what she is expected to pay, with a clear statement that it is an estimate based on the benefits confirmed on a stated date. It also notes that the final amount depends on the plan's processing of the claim and that additional services ordered at the visit would change it. A plain, one-page estimate prevents most surprise-bill complaints.
Uninsured and Self-Pay Patients
Patients without insurance, or who choose not to use it, have a right under federal No Surprises Act rules (45 C.F.R. ยง 149.610) to a written good faith estimate before scheduled services. The practice must provide it within set time frames and include expected charges from other providers involved in the care where required. If the final bill exceeds the estimate substantially, the patient can dispute it. Billing staff need a template and a workflow for these estimates, not an improvised quote.
Why Verification Pays
Verification is time-consuming, but it prevents denials that cost far more to correct. Billing and insurance-related activities already consume a large share of practice revenue, estimated at 14.5% of professional revenue for primary care visits in one study (Tseng et al., 2018). Each claim denied for eligibility or missing authorization adds rework on top of that cost, and some are never recovered.
Recording the Verification
The specialist documents the verification in the practice management system: the date and time, the source, the reference number for any phone call, the name of the plan representative, the benefits confirmed and the authorization number. If the plan later denies the claim, this record supports an appeal. Without it, the practice has only its word against the payer's.
Protecting Information
Verification uses protected health information, and calls to plans must share only what is needed. Estimates sent by email or portal should go only to the patient or a person the patient has authorized. The HIPAA Privacy Rule allows these payment activities but expects reasonable safeguards (U.S. Department of Health and Human Services, 2022).
When the Estimate Changes
Estimates can change for good reasons. If the orthopedist decides at the visit that an injection is also needed, Ms. T.'s share rises. If another claim reaches her plan first and uses up the rest of her deductible, her MRI share falls. The billing specialist tells Ms. T. at booking that the estimate reflects benefits on the day checked and that the office will call if anything changes before the scan. Updating the estimate when the plan of care changes keeps the patient's trust and reduces disputes after the bill arrives. The practice also offers a payment plan for balances above a set amount, which the specialist mentions with the estimate.
Conclusion
Benefits verification turns an insurance card into a clear answer about coverage, rules and cost. For Ms. T., it confirmed active coverage and network status, secured prior authorization and produced an estimate of $550 with the arithmetic shown. Done every time and documented well, it protects patients from surprises and the practice from avoidable denials.
References
Murphy, J., Beauchamp, N., Sun, K. J., Lau, B. D., Wilson, R. F., Lobner, K., Conway, S. J., Hill, P. M., & Johnson, P. T. (2026). Adverse effects of health plan prior authorization on clinical effectiveness and patient outcomes: A systematic review. The American Journal of Medicine, 139(1), 24-32.e1. https://doi.org/10.1016/j.amjmed.2025.08.018
Tseng, P., Kaplan, R. S., Richman, B. D., Shah, M. A., & Schulman, K. A. (2018). Administrative costs associated with physician billing and insurance-related activities at an academic health care system. JAMA, 319(7), 691-697. https://doi.org/10.1001/jama.2017.19148
U.S. Department of Health and Human Services. (2022). Summary of the HIPAA privacy rule. https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html
HCA 110 Module 2 instructions, in plain terms
Verifying benefits appears by name in the HCA 110 catalog description, and with the module prompt kept inside the classroom, the catalog wording anchored this example. Assignments on verification usually ask you to explain each step of checking coverage, identify the benefit details that decide the patient's share and produce an estimate. Some also ask about prior authorization or the rules for uninsured patients. Check whether your prompt supplies a case with numbers or asks you to create one. If it supplies numbers, use them exactly and show every step of the calculation. Look for a required format, such as a paper, a script for the patient call or a completed verification form, and match it.
How this HCA 110 Module 2 example is built
This example is about 1,050 words long, set out in fourteen sections with one table. It opens with the case and then follows five steps in order: eligibility, network status, benefit details, prior authorization and the arithmetic. The benefit table lists the deductible, copay, coinsurance, out-of-pocket maximum and authorization rule. After the calculation, sections explain how to write the estimate, how good faith estimates work for self-pay patients and why verification saves money. The closing sections deal with documenting the call, protecting information and updating the estimate if care changes. Margin notes explain why network status is a separate step and why the arithmetic is shown in full.
Reading the HCA 110 Module 2 grading rubric
Verification papers are often assessed on accuracy of the benefit calculation, completeness of steps, patient communication and use of sources. The calculation here can be checked: the deductible is met first, coinsurance applies to the rest and the copay stays separate. Completeness shows in the five steps and the documentation section. Patient communication appears in the written estimate and the note about payment plans. Sources include a systematic review on prior authorization and a cost study on billing work, both referenced in APA style. Markers also watch whether terms are used correctly, especially the difference between a deductible and coinsurance, and that the paper never promises a final amount the plan has not yet decided.
HCA 110 Module 2 help: mistakes that cost marks
The error seen most in cost estimates is applying coinsurance to the whole allowed amount before the deductible is met. Work the deductible first. Students also forget that a copay is usually outside the deductible, or leave out the out-of-pocket maximum. Another gap is treating active coverage as proof that the provider is in network. When your case gives different numbers, redo the arithmetic step by step and show it. If you want your calculation or draft checked before submission, our tutors can go through it with you and explain any step that does not add up. Round only at the final step, and label each amount so a reader knows who pays it.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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- HCA 110 Module 7: Analyzing Denied Claims
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HCA 110 Module 2 questions, answered
What does HCA 110 Module 2 usually ask for?
The HCA 110 catalog description includes verifying benefits, so a verification and cost estimate exercise is typical. Follow the instructions in your Aspen classroom.
What is the difference between a deductible and coinsurance?
The deductible is the amount the patient pays before the plan shares costs; coinsurance is the percentage the patient pays after the deductible is met.
What is a good faith estimate?
A written estimate of expected charges that uninsured or self-pay patients are entitled to for scheduled services under federal No Surprises Act rules.
Where can I find a free HCA 110 Module 2 sample paper?
The full verification paper above, with its benefit table and the $550 estimate worked step by step, is open to everyone. It is the second of eight HCA 110 samples.
What is prior authorization in HCA 110 Module 2?
Approval a health plan requires before certain services, such as an MRI, for the service to be covered. Missing it is a common cause of denied claims.