MOA 115 Chapter 16 Study Guide

third-party payers

Entities that make payment on an obligation or debt but are not parties of the contract that created the debt.

self-funded plans

Organizations that fund their own insurance programs offer their employees

deductible

The amount of money the policyholder pays per claim or per accident toward the total amount of an insured loss before the company will pay on the claim is known as the

benefits

The amount payable by an insurance company for a monetary loss to an individual insured by that company, under each coverage is called the

Medicaid

The federal-and state-sponsored health insurance program for the medically indigent is called

allowable amount

The maximum amount of money third-party payers will pay for a specific procedure or service is called the

participating provider

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a

CHAMPVA

Veterans of the U.S. armed forces may be covered by

a. Healthcare costs are usually contained b.Access to specialized care and referrals is limited c. Most preventive medical treatment is covered d. Out-of-packet expenses tend to be less than traditional insurance

Which of the follow is not an advantage of managed care?

a. Impatient hospital charges b. Hospice services c. Physician' office visits d. Home healthcare charges

Which of the following expenses would be paid by Medicare Part B?

a. A 66-year old retired woman b. A blind teenager c. A 23-year old recipient of AFDC d. A person dialysis

Which of the following individuals would not normally be eligible for Medicare?

a. Authorized services usually are covered b. Physicians' choices in the treatment of patients can be limited c. More paperwork may be necessary d Reimbursement is historically less than with traditional health insurance

Which of the following is not a disadvantage of managed care?

a. A b. B c. C d. D

Which part of Medicare covers prescription drug services?

a.Staff model b. Independent practices association c. Group model d. None of the above

Which type of HMO model consists of physicians with separately owned practices who formally organize into a group but continue to practice in their own offices?

group policy

A policy that covers a number of people under a single master contract issued to the employer or to an association with which they are affiliated and that is not self-funded is usually called

utilization review

A review of individual cases by a committee to make sure that services are medically necessary and to study how providers use medical care resources is called a(n)

a. an individual policy b. workers' compensation c. unemployment insurance d. disability insurance

A type of insurance that protects workers from loss of wages after an industrial accident that happened on the job is called

TRICARE

Health insurance designed for military dependents and retired personnel is called

premium

The amount of money paid to keep an insurance policy in force is the