Homework Answers
44. Option B is correct as the HMOs (health maintenance organizations) is offering health insurance mode that offers the least flexibility for patient.
45. Option D is correct as all the given services must be covered by Medicaid in each state as per the norms of the American healthcare system, family planning service, transportation of medical care, nurse midwife services.
25. Option D is correct as A certain percentage of the allowed amount that the policyholder is responsible for is : Coinsurance
26. Option A is correct as a designated person who receives fund from an insurance policy is designated beneficiary
27. Option C is correct as a formal request for payment from an insurance company for service provided is known as claim
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The health insurance mode that offers the least flexibility 44. a. fee-for-service. b. health maintenance organizations....
A document sent by the insurance ch explanation or treimbursed for servioey to the provider and...
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...
Private health insurance coverage includes the following types: A. Preferred Provider Plans B. Health Maintenance Organizations...
Private health insurance coverage includes the following types: A. Preferred Provider Plans B. Health Maintenance Organizations C. Indemnity Plans D. All of the above
pilallon. u Uchinition of 57. The process of determining if a procedure or service is covered...
pilallon. u Uchinition of 57. The process of determining if a procedure or service is covered by the insurance plan and what the reimbursement is for that procedure is the definition of a. eligibility b. precertification. c. medical necessity. d. capitation 38. The provider is paid a set amount for cach enrolled person assigned to them, per period of time whether or not that person has received services is the definition of a. eligibility b. Precertification. c. medical necessity. d....
Comparing Private Insurance P Alison purchases health insurance coverage for herself and her spouse. This is...
Comparing Private Insurance P Alison purchases health insurance coverage for herself and her spouse. This is an example of a group urance plan Indemnity, or fee-for-service, plans and managed care plans cover medical expenses if you are sick or injured, but in different ways. The following questions examine the general differences between the two plans. Taking a closer look at how these plans provide coverage will help you begin to customize a health care plan that best suits your requirements....
4. KEY TERMS Multiple Choice Circle the letter of the choice that best matches the definition...
4. KEY TERMS Multiple Choice Circle the letter of the choice that best matches the definition or answers the question 1. A list of the medical services covered by an insurance policy C. Noncovered services D. Fee-for-service A. Health care claim B. Schedule of benefits 2. Health plans are often referred to as: C. Providers D. Payers A. Policyholders B. Subscribers managed care network of providers under contract to provide services at discounted fees. A. Health Maintenance Organization (HMO) B....
AH Sfganization that processes claims and provides administrative services for another organization is utilization management. b....
AH Sfganization that processes claims and provides administrative services for another organization is utilization management. b. resource-based relative value system. third-party administrator. d. provider network. a. C. 37. The Affordable Care Act includes which of the following categories of essential health benefins a. Emergency services b. Laboratory services c. Prescription drugs d. All of the above 38. Services that are needed to improve the patient's current health are considered a. elective. b. preventive. c. medically necessary. d. provider network. 39....
Hello there could you please answer to this question. CHAPTER 16 Basics of Health Insurance 315...
Hello there could you please answer to this question.
CHAPTER 16 Basics of Health Insurance 315 of different at a fixed have sepa association thcare pro providers er fee-for- 5. Rather ae HMO nt's PCP with the annually the cost Preferred Provider Organization APPO is a managed care nework that contracts with a group of providers the providers are on a predetermined list of charges for all services, including those for both normal and complex proce- dures. The PPO model...
1) The most common approach to health and healthcare in America is A) Reactive Health Approach...
1) The most common approach to health and healthcare in America is A) Reactive Health Approach B) Proactive Health Approach C) Health Promotion Approach D) Health Maintenance Approach 2) The Proactive Health Approach is A) treatment oriented. B) more costly than reactive health. C) prevention oriented. D) highly promoted by the insurance industry 3) The Reactive Health Approach is A) prevention oriented. B) leads to a high degree of health and wellness. C) less costly than proactive health. D) treatment...
1) Under the Affordable Care Act, all employers must offer health insurance. True or false? 2)...
1) Under the Affordable Care Act, all employers must offer health insurance. True or false? 2) As a result of the ACA, everyone’s personal income taxes increased from 2010 through 2016. True or false? 3) Entitlement programs offer less discretion to states in policy implementation than block grant programs. True or false? 4) Use of a “gatekeeper,” usually a Primary Care Physician, is used by managed care organizations as a common: a) cost containment strategy b) service utilization control strategy...
69) A policy that pays you back for actual expenses is called A) An indemnity plan....
69) A policy that pays you back for actual expenses is called A) An indemnity plan. B) A deductible plan. C) A reasonable and customary plan. D) A reimbursement plan. E) A coinsurance plan m The set amount that you must pay toward medical expenses before the insurance company pays benefits is called A) Deductible. B) Reimbursement C) Indemnity. D) Internal limit. E) Reasonable and customary charges. 71) Which of the following is a government health care program? A) Health...
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...
pilallon. u Uchinition of 57. The process of determining if a procedure or service is covered by the insurance plan and what the reimbursement is for that procedure is the definition of a. eligibility b. precertification. c. medical necessity. d. capitation 38. The provider is paid a set amount for cach enrolled person assigned to them, per period of time whether or not that person has received services is the definition of a. eligibility b. Precertification. c. medical necessity. d....
Comparing Private Insurance P Alison purchases health insurance coverage for herself and her spouse. This is an example of a group urance plan Indemnity, or fee-for-service, plans and managed care plans cover medical expenses if you are sick or injured, but in different ways. The following questions examine the general differences between the two plans. Taking a closer look at how these plans provide coverage will help you begin to customize a health care plan that best suits your requirements....
4. KEY TERMS Multiple Choice Circle the letter of the choice that best matches the definition or answers the question 1. A list of the medical services covered by an insurance policy C. Noncovered services D. Fee-for-service A. Health care claim B. Schedule of benefits 2. Health plans are often referred to as: C. Providers D. Payers A. Policyholders B. Subscribers managed care network of providers under contract to provide services at discounted fees. A. Health Maintenance Organization (HMO) B....
AH Sfganization that processes claims and provides administrative services for another organization is utilization management. b. resource-based relative value system. third-party administrator. d. provider network. a. C. 37. The Affordable Care Act includes which of the following categories of essential health benefins a. Emergency services b. Laboratory services c. Prescription drugs d. All of the above 38. Services that are needed to improve the patient's current health are considered a. elective. b. preventive. c. medically necessary. d. provider network. 39....
Hello there could you please answer to this question.
CHAPTER 16 Basics of Health Insurance 315 of different at a fixed have sepa association thcare pro providers er fee-for- 5. Rather ae HMO nt's PCP with the annually the cost Preferred Provider Organization APPO is a managed care nework that contracts with a group of providers the providers are on a predetermined list of charges for all services, including those for both normal and complex proce- dures. The PPO model...
69) A policy that pays you back for actual expenses is called A) An indemnity plan. B) A deductible plan. C) A reasonable and customary plan. D) A reimbursement plan. E) A coinsurance plan m The set amount that you must pay toward medical expenses before the insurance company pays benefits is called A) Deductible. B) Reimbursement C) Indemnity. D) Internal limit. E) Reasonable and customary charges. 71) Which of the following is a government health care program? A) Health...
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