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Exam 2: Understanding Managed Care: Insurance Plans

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Question 31

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To avoid the higher costs of healthcare, employers: A)hired younger employees. B)refused to extend health insurance to employees. C)increased employee premium contributions. D)decreased the number of health plans available to employees.

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increased ...

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Question 32

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A goal of managed care is for the patient to receive care in the most appropriate and most restrictive setting.

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Question 33

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Disadvantages of managed care include all of the following EXCEPT: A)it includes disease management programs based on recent research. B)it creates an increased administrative burden. C)it may require physicians to carry additional malpractice insurance. D)it restricts physicians' latitude in caring for patients.

Insurance information obtained by the medical office specialist is: A)stored in the patient's medical record. B)stored separately from clinical information. C)updated on a regular basis. D)verified via phone with the insurance company.

A(n) __________ medical condition is a diagnosis for which the insured has previously been treated and that may not be covered under the terms of some insurance plans.

The restrictions in a health maintenance organization (HMO) reduce members' premium costs.

Point-of-service (POS) plans require members to select a primary care physician (PCP).

Which of the following is true of self-insured plans?

The most restrictive type of managed care plan is the: A)exclusive provider organization (EPO). B)health maintenance organization (HMO). C)individual practice association (IPA). D)preferred provider organization (PPO).

The amount that insured individuals have to pay out of pocket before insurance begins paying is called the __________ .

Which of the following is a characteristic of a preferred provider organization (PPO)? A)It includes a contracted network of providers. B)Members select a primary care physician (PCP) as a gatekeeper. C)The plan is more restrictive than a health maintenance organization (HMO). D)Members must obtain referrals to see a specialist.

A managed care organization (MCO) collects data on care delivery, such as identifying the percentage of children in a health maintenance organization (HMO) who have been immunized.

All health insurance contracts define medical necessity in the same way.

Which type of statement signed by the patient authorizes his or her insurance company to send payments directly to the provider? A)Assignment of benefits B)Authorization to release protected health information C)Advance directive D)Beneficiary designation

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Which of the following is true of COBRA insurance?

A(n) __________ model health maintenance organization (HMO) contracts with more than one community-based multispecialty group to provide wider geographical coverage.

List four goals of managed care.

The HMO Act of 1973 used federal funds for the purpose of: A)promoting health maintenance organizations (HMOs). B)increasing restrictions on HMOs. C)developing new managed care corporations. D)establishing a regulatory board for HMOs.

It is possible for a health maintenance organization (HMO) member to receive care from a non-network provider or facility in an emergency situation.