Chapter 13: Health Insurance Providers Complete With Questions And Answers Latest Update

Maria is a Preferred Provider Organization (PPO) subscriber and received care from an out-of-network provider. Which of the following is the likely result? Care is covered Care is not covered Care is only covered in a government facility Care is only covered if primary care physician gives a referral - ANSWER A) Care is covered How much does Medicare Part B pay for physician fees? 40% 60% 80% 100% - ANSWER C) 80% Which of the following is NOT taken into consideration when determining eligibility for Medicare benefits? Chronic kidney disease Income Age Social Security disability - ANSWER B) Income Medicare Part A covers what type of care? Skilled nursing facility care Major Medical facility care Custodial facility care Respite facility care - ANSWER A) Skilled nursing facility care An accident and health policy that provides reimbursement benefits makes them payable to the provider facility providing service insured insured's spouse - ANSWER C) insured Which of the following is an example of a third-party administrator? Outside organization that manages a sales team Outside organization that processes claims for an employer's self-funded group plan Outside organization that serves as an arbitrator in Social Security claims Outside organization that conducts investigations into fraudulent claims - ANSWER B) Outside organization that processes claims for Medicare provides coverage for each of the following EXCEPT hospital room and board doctor and surgeon services prescription drugs custodial care - ANSWER D) custodial care Paul is an employee who caught a disease unique to the trade in which he was exposed to. Paul has a(n) genetic predisposition worksite malady contagious disease occupational disease - ANSWER D) occupational disease Which of the following services are health maintenance organizations (HMO's) NOT required to provide? Emergency services Hospitalization