Comprehensive Health Insurance Chapter 2-Understanding Managed Care:Insurance Plans: Study Guide for Quiz

The duties of a primary care physician (PCP) in a health maintenance organization (HMO) include:

Acting as a gatekeeper to services, coordinating patient care, referring patients to specialists.

To determine the amount due from a patient, it is necessary to know the:

Allowed amount

In a managed care organization (MCO), a primary care physician (PCP) is typically any of the following EXCEPT:

Dermatologist

Utilization guidelines are used to:

Determine if the services are medically necessary.

The purpose of a withhold program is to:

Encourage providers to use cost effective methods.

The major types of managed care plans are:

HMO< PPO< and POS

To avoid the higher costs of healthcare, employers:

Increased employee premium contributions.

As government program healthcare cost increased, federal and state governments:

Increased taxes

Which of the following plan types does not use a network of providers:

Indemnity plan

During the first half of the 20th century, most doctors were paid directly by:

Individuals

The goals of managed care include all of the following EXCEPT:

Medical care rendered in the most profitable setting.

Terms used to refer to fees in an insurance contract include all of the following EXCEPT:

Ordinary

The subscriber in an HMO organization can also be called:

Policy holder or member.

The HMO Act of 1973 used federal funds for the purpose of:

Promoting HMOs.

Managed care systems ensure the delivery of high-quality care while managing costs through:

Provider, networks, and discounted fee for services.