Health Insurance Exit Quiz

Which of the following best describes a health plan “provider network?"

• The hospitals and doctors that contract with your health plan to provide services for an agreed-upon rate or fee schedule.

• The computer system doctors and hospitals use to submit bills to insurance companies.

• A website where consumers can find information about the best doctors.

True or false: If you receive inpatient care at a hospital that participates in your health plan’s provider network, all the doctors who care for you while you’re in the hospital will also be in network.

• True

• False

Suppose your health plan covers lab tests in full if you go to an in-network lab, but only pays 60% of allowed charges if you go out of network. You forget to check and go get your blood test at a lab that turns out to be out of network. The lab bills you $100 for the blood test. Your health insurance allows only a $20 charge for that test. How much would you have to pay out of pocket for that lab test?

• $0

• $40

• $60

• $88

True or false? If your health insurance or health plan refuses to pay for a service that you think is covered and your doctor says you need, you can appeal the denial and possibly get the insurance company to pay the claim.

• True

• False

What happens if you don't have health insurance (Select all that are true)

• You can be refused treatment unless it is a life threatening situation

• You have to pay for all of your healthcare expenses at full cost

• You have to pay a fine when you do your taxes, or your tax refund is garnished

• You can't go to the doctor because you cannot pay your bill

• You may qualify for coverage through your state, if you have a low income