Question

A document sent by the insurance ch explanation or treimbursed for servioey to the provider and the patient explaining the allowed S, and the patient's financial responsibilities is r service of benefit b. fee schedule. c. claim. d. policy 29. A list of the fixed fees for services is a a. explanation of benefits. b. fee schedule. c. claim. d. policy 30. In some managed care plans referrals to a specialist must be approved by the a. beneficiary b. gatekeeper c. third-party administrator. d. policyholder Someone who is poor, needy, or impoverished is conside a. uninsurable. b. 31. a cash only patient. indigent d. c. None of the above 32. A written agreement between two parties, where one party agrees to pay another party if certain specified circumstances occur is a a. policy b. preauthorization c. referral. d. fee schedule 33. An order from a primary care provider for the patient to see a specialist is a(n) a. preauthorization b. policy c. referral. heaith insurance exchange. d. An approved list of physicians, hospitals, and other providers is a(n) 34. a. explanation of benefits. b. health insurance exchange. c. third-party administrator. d. provider network A process required by some insurance carriers in which the provider obtains permission to perform 35. certain procedures or services is a. preauthorization. b. referral. c. utilization management.

Answer 1

28.A.Explanation of benefits  

The insurance company send a document to the patient explaining the benefits, they provided to the patient.It is called explanation of benefits.A claim is given by a policy holder.

29.b.fee schedule

Fee schedule/fee structure is a list of goods and services and allocated fee and it is fixed for each and every one.

30.C.Third party administrator

It is an entity which process insurance claims.In order to refer a patient to other specialities,the approval from the third party administrator is needed.

31.C.Indigent

Indigent is a person who is extremely poor and lack of money and valuable resources.

32.a.Policy

Policy is a set of guidelines for any entity to act in various situations.The above statement indicates the policy.

33.C- Referral

When a physician found that it is necessary for the patient to be consulted by a specialist for further treatment.And the physician refer the patient to a specialist

34.D.Provider network

It is a list of doctors,nurses and other health team members available for treatment of the members of the network.

35.a.preauthorisation

Pre-authorisation is required from the patient by insurer to give you any kind of treatment.But when patient requires an emergency care,this pre-authorisation is not required.