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.