Claim Inputs
Enter invoice values and coverage terms.
Example Data Table
This sample illustrates typical entry patterns for travel evacuations.
| Scenario | Transport | Medical | Fees | Other | Policy limit | Deductible | Coinsurance |
|---|---|---|---|---|---|---|---|
| Domestic ground + ER | 2,800 | 3,400 | 300 | 200 | 25,000 | 250 | 10% |
| International air evac | 25,000 | 6,000 | 1,200 | 800 | 50,000 | 500 | 10% |
| Remote helicopter transfer | 45,000 | 8,500 | 1,800 | 1,100 | 60,000 | 1,000 | 20% |
Formula Used
This calculator models typical reimbursement logic using transparent steps.
- Convert currency: USD = Amount ÷ FX rate.
- Apply sublimits: Evac eligible = min(Evac cost, Evac sublimit).
- Apply sublimits: Medical eligible = min(Medical cost, Medical sublimit).
- Gross eligible: Eligible = Evac eligible + Medical eligible + Other eligible.
- Apply overall cap: Eligible = min(Eligible, Policy limit).
- Coverage percent: Eligible = Eligible × Coverage%.
- Adjustments: Eligible = Eligible × Network × Preapproval × Docs × Reasonability.
- Deductible: AfterDed = max(0, Eligible − DeductibleApplied).
- Coinsurance: GrossPay = AfterDed × (1 − Coinsurance%).
- Fees and advances: NetPay = GrossPay − Fee%; Remaining = max(0, NetPay − Advance).
- Out-of-pocket: OOP = Total incurred − Total insurer paid.
How to Use This Calculator
- Gather invoices for transport, treatment, and assistance services.
- Enter your coverage caps, deductibles, and coinsurance terms.
- Set documentation and preapproval options to match reality.
- Click Calculate Claim to see payout and out-of-pocket.
- Download CSV or PDF for sharing with your adjuster.
- Run scenarios by changing limits and coverage assumptions.
Cost drivers in medical evacuation claims
Medical evacuation invoices usually combine transport, clinical support, and coordination. Air ambulance trips can run from 15,000 to 80,000 depending on distance, medical team level, and aircraft type. Ground transfers and local stabilization often add 500 to 10,000. Enter each line item separately to see which component pushes the claim above caps.
How limits and sublimits change eligibility
Many plans apply an overall limit and a dedicated evacuation sublimit. If your transport cost is 55,000 but the evacuation sublimit is 30,000, only 30,000 can be eligible before other rules. Medical treatment caps may also restrict hospital charges. This calculator applies those ceilings first, then recomputes the eligible base.
Deductible and coinsurance impact
After limits, deductibles reduce the eligible amount dollar for dollar. Coinsurance then splits the remaining amount between you and the insurer. For example, a 500 deductible and 10% coinsurance on 20,000 eligible produces 17,550 insurer share: (20,000−500)×0.90. Adjust these fields to test worst‑case and best‑case outcomes.
Documentation, approvals, and reasonability factors
Claims often hinge on proof: physician orders, transport logs, itemized bills, and payment receipts. Missing documentation can trigger reductions or denials. The calculator models this with a documentation factor plus optional preapproval and reasonability factors. Use “partial” or “weak” when records are incomplete, or when pricing appears above usual‑and‑customary levels.
Scenario planning and exporting results
Use the FX rate input when invoices are not in USD so totals stay comparable. Run multiple scenarios by changing limits, eligibility percent, and factor settings, then export CSV or PDF for your adjuster and for your own budgeting. The waterfall chart shows how each rule step changes the estimate, making it easier to explain results. If an assistance provider paid an advance, record it to estimate remaining reimbursement. You can also model a small processing fee when billing is outsourced. Keep incident notes and discharge summaries to strengthen documentation and support medical necessity.
FAQs
1) What costs should I include in the claim inputs?
Include transport, emergency medical treatment, coordination or assistance fees, and other eligible items such as lodging or ground transfers. Use itemized invoices so each category is defensible.
2) What does “coverage eligibility %” represent?
It models partial coverage situations, such as exclusions, non-covered providers, or benefit reductions. If you expect only part of the claim to qualify, set the percentage below 100.
3) How should I use FX rate for non‑USD bills?
Enter the invoice amounts in your bill currency, then set FX as “1 USD equals how much currency.” The calculator converts to a consistent base for math and returns results in your chosen currency.
4) Why do documentation and preapproval affect the estimate?
Insurers may reduce or deny claims without clear medical necessity, itemized billing, and required authorizations. These options let you stress-test outcomes when paperwork is incomplete or approvals were missed.
5) Does the calculator replace my policy language?
No. It provides an estimate using common benefit mechanics. Always verify your plan’s definitions, exclusions, and required steps. If your plan uses different order of operations, adjust assumptions accordingly.
6) What is the difference between net payable and remaining payment?
Net payable reflects the estimated insurer payment after deductibles, coinsurance, and any modeled fees. Remaining payment subtracts any advance already paid, showing what might still be owed to you or providers.