Unit 17

Point-of-service plan

A type of HMO that does not have a gatekeeper and allows subscribers to obtain care from either providers that do or not belong to the HMO is called a

Utilization management

All of the following are alternatives to hospital care except

PPO's operate on a prepaid basis

All of the following are characteristics of a PPO except

Indemnity arrangements

All of the following are examples of managed care plans except

Medical services are provided first, and then they are billed and paid for

All of the following are features of HMO's except

Alternative review

All of the following are points in the process of utilization management except

HMO's operate on a fee for service plan

All of the following statements about an HMO are correct except

Open panel

David has a PPO that does not limit him to use only providers hat have contracts with the PPO. David's PPO is

closed panel

Gwyneth's HMO requires that she receive health care services from a specified, limited number of health care providers chosen by the HMO. Gwyneth's HMO is

Preauthorization

If treatment requiring hospitalization is recommended, the physician of the insured may have to get the expense approved prior to obtaining the treatment. This is known as

Open-panel entities

PPO subscribers are not strictly limited to using providers that have contacts with the PPO. PPO's are

HMO

The gatekeeper concept co-payments and limited choice of provider are characteristics of a

HMOs provide both the health care service and the health care financing, but traditional health care insurance companies provide only the financing

The main difference between traditional health insurance arrangements and HMOs is that

Intermediate nursing facility

Which of the following alternatives to hospital care provides intermittent nursing care for patients who do not need 24 hour supervision?

Second surgical opinion

Which of the following cost saving measures allows or requires insureds to consult a doctor other than their attending physician to see if an alternative method of treatment would be desirable?

Retrospective review

Which utilization management review is done after the treatment is complete?