Questions and Answers
What occurs before the treatment is provided?
In which of the following processes will the insurer oversee the insured's hospital stay?
An example of a primary care physician would be a(n):
What is the gatekeeper's role when used by an HMO?
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Upon delivery of a specified disease insurance policy, Tara the producer may be expected to collect all of the following EXCEPT a(n):
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Study Notes
Health Insurance Underwriting Concepts
- Pre-certification occurs before treatment is administered, serving as a proactive step in cost management.
- Concurrent review involves insurers monitoring a patient's hospital stay to ensure compliance with treatment plans and discharge plans.
Roles of Healthcare Providers
- An internist is classified as a primary care physician, distinguishing them from specialists like psychologists and endocrinologists.
- The gatekeeper role in Health Maintenance Organizations (HMOs) includes obtaining necessary referrals from primary care physicians to specialists, managing patient access to specialized care.
Policy Delivery Procedures
- When delivering a specified disease insurance policy, the producer, Tara, must collect specific documents, but a modified application with a new signature is not typically required at that time.
- The expected documents include the initial premium, a signed impairment rider acknowledgement, and a good health statement.
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Description
Test your knowledge on health insurance underwriting concepts with this quiz focused on Chapter 17. The flashcards cover key terms such as pre-certification and concurrent review. Perfect for students in health insurance or medical underwriting courses.
