CPB Final Exam Correctly Answered 2024.

CPB Final Exam Correctly Answered 2024.EPO - correct answer ...provides benefits to subscribers who are required to receive services from network providers IDS - correct answer ...organizations of affiliated providers sites that offer joint healthcare services to subscribers HMO - correct answer ...providers comprehensive healthcare services to voluntarily enrolled members on a prepaid basis POS - correct answer ...patients can use the managed care panel of providers (paying discounted healthcare cost) or self-refer to out-of-network providers (and pay higher cost) PPO - correct answer ...contracted network of healthcare providers that provide care to subscribers for a discounted fee When a nonparticipating provider files a claim for a patient to BC/BS, how is the payment processed? - correct answer The payment is sent to the patient and the patient must pay the provider. Birthday rule - correct answer the policyholder whose birth month and day occurs earlier in the calendar year holds the primary policy when each parent subscribes to a different health insurance plan Nonparticipating Providers (nonPARs) - correct answer they expect to be paid the full fee charged for services rendered *In these cases, the patient may be asked to pay the provider in full and then be reimbursed by BCBS the allowed fee for each service, minus the patient's deductible and copayment obligations -even when the provider agrees to file the claim for the patient, the insurance company sends the payment for the claim directly to the patient and not to the provider