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Questions and Answers
Health plans base reimbursement on the final diagnosis rather than a patient's presenting symptoms.
Health plans base reimbursement on the final diagnosis rather than a patient's presenting symptoms.
False (B)
If a patient's severe chest pain turns out to be heartburn rather than a heart attack, the health plan must cover the emergency department care.
If a patient's severe chest pain turns out to be heartburn rather than a heart attack, the health plan must cover the emergency department care.
True (A)
Urgent and Emergent claims are considered at the Out of Network (OON) benefit level.
Urgent and Emergent claims are considered at the Out of Network (OON) benefit level.
False (B)
Severe and/or persistent vomiting is commonly identified as an Urgent / Emergent condition.
Severe and/or persistent vomiting is commonly identified as an Urgent / Emergent condition.
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If the provider is in-network and the claim is denied, it is the provider's responsibility.
If the provider is in-network and the claim is denied, it is the provider's responsibility.
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