Coinsurance payment - Study guides, Class notes & Summaries

A medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in that geographic area is known as Usual, customary and reasonable What provision would prevent an insurance company from paying a reimbursement claim to someone other than the policyowner? Payment of Claims All of the following are true about gr...

Ray has an individual major medical policy that requires a coinsurance payment. Ray very rarely visits his physician and would prefer to pay the lowest premium possible. Which coinsurance arrangement would be the best for Ray? a- 75/25 b- 80/20 c- 90/10 d- 50/50 - Answer d- 50/50. After the deductible has been paid, the insurance company will pay a specified amount for a physician's visit, while the insured pays the remaining percentage. This is called "coinsurance". Plans will ofte...

Texas Life And Health Insurance Exam Questions With Correct Answers | Latest 2023/2024 (Graded A+). Which of the following actions is NOT possible with a Universal Life policy? - Correct Answer-Premiums may be applied as a credit against income tax Which of the following will a Long Term Care plan typically provide benefits for? - Correct Answer-home health care Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that...

Test Bank for Medical-Surgical Nursing 5E Holly Stromberg Chapter 01: Caring for Medical-Surgical Patients Stromberg: Medical-Surgical Nursing: Concepts and Practice, 5th Edition MULTIPLE CHOICE 1. Which statement accurately describes the primary purpose of the state nurse practice act (NPA)? a. To test and license LPN/LVNs b. To define the scope of LPN/LVN practice c. To improve the quality of care provided by the LPN/LVN d. To limit the LPN/LVN employment placement ANS: B While improv...

New York Life Insurance Questions and Answers Already Passed Accelerated Benefits Riders attached to life insurance policies which allow death benefits to be used to cover nursing or convalescent home expenses. Accidental Death Benefits A policy rider that states that the cause of death will be analyzed to determine if it complies with the policy description of accidental death. Accidental Death Insurance An insurance policy that provides payment if the insured's death is the result of an acc...

If a company cancels an auto policy mid term, the refund will be made on a. pro rata basis b. short rate basis c. retroactive basis d. coinsurance basis Pro Rata Basis What is the term used to describe terminating the insurance relationship at the end of the policy period ? a. cancellation b. nonrenewal c. separation d. exclusion Nonrenewal Which is the best example of an indirect loss ? a. sequential loss b. liability loss c. employee theft d. loss of use Loss o...

Calculate the amount of money a patient would owe for a noncovered service costing $900 if their indemnity policy has a coinsurance rate of 80-20, and they have already met their deductible correct answers $900 Calculate the monthly capitation payment a provider should receive from a health plan if they have 80 contracted patients and a capitated payment of $40 per month correct answers The monthly capitation payment would total $3,200 (80 x $40 = $3,200). A capitated payment amount is cal...

NJ Accident and Health Producer Practice Exams Latest Update Graded A+ According to the Time Payment of Claims provision, the insurer must make the payment immediately after receiving proof of loss EXCEPT: - if the insured is able to eventually return to work -if the death is suicide or due to a pre existing condition -when the policy is in the incontestability period -for claims involving periodic payments for claims involving periodic payments INSURERS MUST PAY LUMP SUM CLAIMS I...

MNT II: Billing And Coding Questions And Answers 2024/2025 Solutions Health care provider or supplier agrees (or is required by law to accept the third party payer-approved amount as full payment for covered services and not to bill the client for any more than the deductible and coinsurance. ANS Accept Assignment A group of care providers who give coordinate care and chronic disease management, and thereby improve the quality of care patients get. The organization's payment is tied to a...

Life and Health Insurance Final Exam Questions with Verified Solutions ________ is a health insurance policy that only covers physician services and procedures. Proves first dollar benefits by the insurer, but low coverage limits. Basic Medical Expense ________ is a health insurance policy that only covers room and board if the insured stays overnight in a hospital and the miscellaneous expenses that occur because of that stay. Basic Hospital Expense ________ is a health insurance p...