MAH116 Assignment 1.2 Insurance Plans
1. For each of the following managed care plans, describe the deductible, coinsurance, and copayment requirements.
a. Health maintenance organization (HMO):
b. Preferred provider organization (PPO):
c. Exclusive provider organization (EPO):
2. A(n) ____________is a review of individual cases by a committee to make sure services are medically necessary and study how providers use medical care resources.
3. A(n) _____________is a healthcare provider who enters into a contract with a specific insurance company or program and agrees to accept the contracted fee schedule.
4. The_______________ is the maximum that third-party payers will pay for a procedure or service.
5. One of the medical assistant’s responsibilities is verifying eligibility. Describe the processes available for the verification of eligibility for services.
6. Match the types of insurance benefits with their description.
____ Liability insurance
____ Life insurance
____ Long-term care insurance
a. Provides payment of a specified amount upon the insured’s death
b. Covers a continuum of broad-range maintenance and health services to chronically ill, disabled, or mentally disabled individuals
c. A form of insurance that provides income replacement if the patient has a non–work-related injury.
d. Often includes benefits for medical expenses related to traumatic injuries and lost wages payable to individuals who are injured in the insured person’s home or in an automobile accident
2)the answer is utilization review,utilization review help to review that all the benefits are provided based on their plan and review how providers are use medical resources. . There are three type of assess are in utilization review that include retrospective ,concurrent and prospective.
3)correct answer is participating providers. These providers are voluntarily and in advance enter into the contract and agree the fees schedule demand by insurance company.
4)the answer is allowable charge or amount .this is referred as maximum amount that third party will pay for services .
6) a) provide payment of a specified amount upon the insured's death ___Life insurance
b) cover a continuum of broad range maintainance and health services to chronically ill, disabled or mentally disabled individual ___Long term care insurance
c) A form of insurance that provides income replacement if the patient has a non -work related injury ___disability insurance
d) often include benefits for medical expenses related to traumatic injuries and lost wages payable to individuals who are injured in the insured persons's home in OR an automobiles accidents ___Liability insurance .
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