AHIP CERTIFICATION 2024 EXAM QUESTIONS AND DETAILED ANSWERS| A+ GRADE
AHIP CERTIFICATION 2024 EXAM QUESTIONS AND DETAILED ANSWERS| A+ GRADE Mr. Zachow has a condition for which three drugs are available. He has tried two but had an allergic reaction to them. Only the third drug works for him and it is not on his Part D plan's formulary. What could you tell him to do? Correct Answer Mr. Zachow has a right to request a formulary exception to obtain coverage for his Part D drug. He or his physician could obtain the standardized request form on the plan's website, fill it out, and submit it to his plan. Mr. Polanski likes the cost of an HMO plan available in his area, but would like to be able to visit one or two doctors who aren't participating providers. He wants to know if the Point of Service (POS) option available with some HMOs will be of any help in this situation. What should you tell him? Correct Answer The POS option might be a good solution for him as it will allow him to visit out-of-network providers, generally without prior approval. However, he should be aware that it is likely he will have to pay higher cost-sharing for services from out-ofnetwork providers. Mr. Ans recently and expected that he would have certain services and items covered by the plan with minimal out-ofpocket costs because his MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit that included a number of services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him? Correct Answer You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. Ms. Stuart has heard about a special
Información del documento
- Subido en
- 14 de febrero de 2024
- Número de páginas
- 88
- Escrito en
- 2023/2024
- Tipo
- Examen
- Contiene
- Preguntas y respuestas
