Chapter 13: Health Insurance Providers

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 organizatio