HCMG EXAM 3 LECTURE 4 QUESTIONS
AND ANSWERS 100% CORRECT
What is the significance of surprise medical bills in each type of insurance model? -
ANSWER-In public insurance (medicare/medicaid), surprise medical bills are not an
issue here because medicare and medicaid have already negotiated with doctors
across the board.
In private insurance, surprise medical bills show up here. Employer negotiates with
insurance company to determine how much the insurance company will contribute, how
much you will contribute out of paycheck
What are the three types of private insurance models? - ANSWER-HMO - If you go to
out of network doctor, you have to pay whatever doctor charges you → no out of
network care paid for by an insurance company
PPO - If you go to out of network doctor, you will pay a lesser rate than what you have
to pay without insurance, but you have to pay more than what you would if you went to
in network doctor
Full Indemnity - You pay a premium (more than HMO and PPO premium), but you can
see whoever you want
What are some research questions associated with surprise medical bills? - ANSWER-
Positive: What is true, what is factual
Is this rare or frequent? Unique to a situation?
Does it happen differently in different health care settings?
Does it happen differently in different locations?
Normative - what is the norm? What should be the norm
Why is it happening?
What can we do about it as consumers and policy makers?
Defining a Surprise Out of Network Bill - ANSWER-To define a surprise medical bill
within a quantitative research question - EMPIRICALLY CHALLENGING.
Inference and data allows us to determine if a bill is a surprise medical bill.
What type of data do researchers look at to determine surprise out of network bill? -
ANSWER-Analyze the data such as Date, time, Hospital Bill
Type of procedure, the cost of the procedure, code, the insurance company (what they
have contributed, and what expected contribution will be)
So bill will have total cost, cost insurer will pay, cost you have to pay
If a doctor negotiates with an insurance company - they are considered in network
Treatment categories that are used to classify cases by potential surprise medical bill
status - ANSWER-For ED (inpatient and outpatient) and elective procedures (inpatient)
services:
AND ANSWERS 100% CORRECT
What is the significance of surprise medical bills in each type of insurance model? -
ANSWER-In public insurance (medicare/medicaid), surprise medical bills are not an
issue here because medicare and medicaid have already negotiated with doctors
across the board.
In private insurance, surprise medical bills show up here. Employer negotiates with
insurance company to determine how much the insurance company will contribute, how
much you will contribute out of paycheck
What are the three types of private insurance models? - ANSWER-HMO - If you go to
out of network doctor, you have to pay whatever doctor charges you → no out of
network care paid for by an insurance company
PPO - If you go to out of network doctor, you will pay a lesser rate than what you have
to pay without insurance, but you have to pay more than what you would if you went to
in network doctor
Full Indemnity - You pay a premium (more than HMO and PPO premium), but you can
see whoever you want
What are some research questions associated with surprise medical bills? - ANSWER-
Positive: What is true, what is factual
Is this rare or frequent? Unique to a situation?
Does it happen differently in different health care settings?
Does it happen differently in different locations?
Normative - what is the norm? What should be the norm
Why is it happening?
What can we do about it as consumers and policy makers?
Defining a Surprise Out of Network Bill - ANSWER-To define a surprise medical bill
within a quantitative research question - EMPIRICALLY CHALLENGING.
Inference and data allows us to determine if a bill is a surprise medical bill.
What type of data do researchers look at to determine surprise out of network bill? -
ANSWER-Analyze the data such as Date, time, Hospital Bill
Type of procedure, the cost of the procedure, code, the insurance company (what they
have contributed, and what expected contribution will be)
So bill will have total cost, cost insurer will pay, cost you have to pay
If a doctor negotiates with an insurance company - they are considered in network
Treatment categories that are used to classify cases by potential surprise medical bill
status - ANSWER-For ED (inpatient and outpatient) and elective procedures (inpatient)
services:
