Health insurance Providers

What is Medicare?

A hospital and medical expense insurance program

Which of the following reimburses its insureds for covered medical expenses?

Commercial insurers (commercial insurance companies function on the reimbursement approach. Policyowners obtain medical treatment from whatever source they feel is most appropriate and submit their charges to their insurer for reimbursement)

Which of the following does social security NOT provide benefits for?

Dismemberment

A medical care provider which typically delivers health services at its own local medical facility is known as a?

HMO - Health maintenance organization

Which of the following BEST describes how a preferred provider organization (PPO) is less restrictive than a health maintenance organization (HMO)?

More physicians to choose from (PPO's normally provide a wider choice of physicians and hospitals)

Which of the following actions is required by an insured who leaves the primary area of medical coverage and seeks medical care?

Obtain prior approval from the insurer for the medical service

Under what system do a group of doctors and hospitals is a designated area contract with an insurer to provide services at a prearranged cost to the insured?

PPO (preferred provider organization, a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured)

Which of these statements is INCORRECT regarding a preferred provider organization (PPO)?

PPO's are NOT a type of managed care systems (PPO's are considered to be a managed health care system)

The individual who provides general medical care for a patient as well as the referral for specialized care is known as a?

Primary care physician

Which of the following statements is true about most blue cross/blue shield organizations?

They are nonprofit organizations