Exam 16: Basics of Health Insurance

The amount of money the policyholder pays per claim or per accident toward the total amount of an insured loss before the company will pay on the claim is known as the

A review of individual cases by a committee to make sure that services are medically necessary and to study how providers use medical care resources is called a(n)

Nearly all of the physician's income is derived from the insurance payments received for services rendered.

The "cafeteria-style" plan allows employers to choose the benefits they want for their respective employees.

Health insurance typically covers services and procedures considered medically necessary.Most insurance policies also cover "elective" procedures,such as certain cosmetic surgeries,that are not considered medically necessary.

The amount of money paid to keep an insurance policy in force is the

Which type of HMO model consists of physicians with separately owned practices who formally organize into a group but continue to practice in their own offices?

Which of the following MCOs typically has/have the lowest monthly premiums with lower patient financial responsibility?

Which of the following referrals can be approved online when it is submitted through the provider's Web portal to the utilization review department?

Which of the following managed care plans require preauthorization for medical services such as surgery?

Which of the following expenses would be paid by Medicare Part B?

Health insurance benefits are determined by

Which of the following pays the hospital surgical room fee?

Which type of referral is usually processed immediately?

TRICARE is a form of government insurance for veterans of the U.S.armed forces.

Which of the following HMO models hires physicians and pays them a salary rather than contracting the physicians to create a network?

The federal- and state-sponsored health insurance program for the medically indigent is called

Health insurance designed for military dependents and retired military personnel is called

Entities that make payment on an obligation or debt but are not parties of the contract that created the debt are called

Which of the following is not a disadvantage of managed care?