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Questions and Answers
What occurs before the treatment is provided?
What occurs before the treatment is provided?
- Costs more to the patient
- Occurs before the treatment is provided (correct)
- Is considered a cost containment measure
- Costs less to the patient
In which of the following processes will the insurer oversee the insured's hospital stay?
In which of the following processes will the insurer oversee the insured's hospital stay?
- Pretense review
- Concurrent review (correct)
- Congruent review
- Pre-certification review
An example of a primary care physician would be a(n):
An example of a primary care physician would be a(n):
- Psychologist
- Endocrinologist
- Chiropractor
- Internist (correct)
What is the gatekeeper's role when used by an HMO?
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):
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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