D. medical services are provided first, and then they are billed and paid for
PPO subscribers are not strictly limited to using providers that have contracts with the PPO. PPO's are
A. open-panel entities
A type of HMO that does not have a gatekeeper and allows subscribers to obtain care from either providers that do or not belong to the HMO is called a
A. point-of-service plan
Which of the following cost saving measures allows or requires insureds to consult a doctor other than their attending physician to see if an alternative method of treatment would be desirable?
B. Second surgical opinion
All of the following are alternatives to hospital care EXCEPT
B. utilization management
The main difference between traditional health insurance arrangements and HMOs is that
C. HMOs provide both the health care service and the health care financing, but traditional health care insurance companies provide only the financing.
Gwyneth's HMO requires that she receive heath care services from a specified, limited number of health care providers chosen by the HMO. Gwyneth's HMO is
D. closed panel
David has a PPO that does not limit him to use only providers that have contracts with the PPO. David's PPO is
B. open panel
All of the following are examples of managed care plans EXCEPT
B. indemnity arrangements
All of the following are characteristics of a PPO
ЕХСЕРТ
D. PPO's operate on a prepaid basis
If treatment requiring hospitalization is recommended, the physician of the insured may have to get the expense approved prior to obtaining the treatment. This is known as
B. preauthorization
All of the following are points in the process of
utilization management EXCEPT
C. alternative review
Which utilization management review is done after the treatment is complete?
C. Retrospective review
Which of the following alternatives to hospital care provides intermittent nursing care for patients who do not need 24 hour supervision?
C. Intermediate nursing facility
All of the following statements about an HMO
are correct EXCEPT
