Chapter 12 Quiz
An authorization by one provider for a patient to see another provider for a specific problem is known as a _____.
referral
Once a member meets the threshold limit, the PPO pays _____.
100 percent of the covered charges
Which statement is not true of a subscriber?
A subscriber is also known as the insurance carrier.
Which was the first managed care system?
Coverage for construction workers at the Grand Coulee Dam
Prepaid health plan in which individuals receive medical services from participating providers
HMO
The most popular choice in managed care is the _____.
HMO
A personal savings account that the participant owns and controls
HSA
Which statement is not true of an HSA?
HSAs are for those without insurance.
Which is not a true statement of a physician provider group?
It's not cost effective for specialists to join the physician provider group.
A group of providers and hospitals who give plan members discounted health care
POS
Plan in which members choose their own medical care providers, with care from a participating provider or facility resulting in increased benefits
PPO
One difference between HMOs and PPOs is that members of _____ can choose their own doctors and treatment facilities and still receive benefits.
PPO's
_____ examine and ensure quality health care in managed care situations.
Peer review organizations
Why do more people need health care?
People are living longer and population continues to grow
Which of the following is not found on the insurance identification card?
Physician Address
_____ strive to combine the best elements of both HMOs and PPOs.
Point of service plans
PPO stands for _____.
Preferred provider organization
The _____ is the doctor in charge of a particular patient in an HMO.
Primary physician
The identification card includes all except the _____.
Providers
If a nonparticipating physician treats an HMO patient, the patient's insurance benefits _____.
are reduced or denied
_____ coverage allows people the most freedom in choosing providers.
fee for services
Managed care was started to help _____.
fight rising healthcare costs
A(n) _____ describes insurance benefits and coverage information.
insurance policy
Private health insurance _____.
operates for profit
_____ are managed care programs that the physicians own.
physician provider groups
