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HCMG Exam 3 Lecture 4 Questions And
Answers. Updated And Verified.
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.
1|Page
HCMG Exam 3 Lecture 4 Questions And
Answers. Updated And Verified.
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.
1|Page
