Week 2 Review

When a payment for a service covered by health insurance is made, what is that payment called?

• Benefit

• Premium

• Deductible

• Assignment

When the insurance company pays 80% of the allowed charge, and the patient pays the remaining 20%, what is the patient’s portion called?

• Benefit

• Deductible

• Co-payment

• Coinsurance

Mary and Tom Weatherly both work and participate in the family health insurance plan offered by their separate employers. What term relates to the rules used by their insurance companies relating to paying for services?

• Coinsurance

• Birthday rule

• Double coverage

• Coordination of benefits

Mary and Tom divorced after a few years. However, they both continued to work and share custody of their children (joint custody). The children reside with Mary. Neither parent has remarried. Tom is the “responsible party” for the children. Whose insurance is the primary insurance for the children?

• Both

• Tom’s

• Mary’s

• The birthday rule applies

Tom's insurance plan is a traditional indemnity insurance plan. If Tom wants to make an appointment with a dermatologist to treat his acne, what must he do?

• Simply make the appointment.

• Obtain a referral from his primary care physician.

• Visit the plan website and fill out a request for referral form.

• Call the insurance company and obtain a preauthorization number.

For which of the following must the patient pay a regular monthly premium?

• Medicare Part A

• Medicare Part B

• Neither A nor B— the cost is the same

• Neither A nor B—there is no cost for either plan

What percentage of the allowed charges will Medicare pay a participating physician for office services if the patient has already met the annual deductible?

• 20%

• 50%

• 80%

• 100%

If a patient has Medicare insurance and a Medicare supplemental policy, which insurance is considered the primary insurance?

• Medicare.

• It depends on the birthday rule.

• Medicare supplemental insurance.

• It depends on the state in which the patient lives.

What type of insurance covers long-term nursing home costs for eligible patients (low-income without savings)?

• Medicaid

• Medicare

• CHIP plans

• None are correct

What name is given to the process where an insurance company determines if a proposed service such as physical therapy is medically necessary?

• Verifying eligibility

• Utilization review

• Explanation of benefits

• Reimbursement