Question

Beverly's doctor recommends she get a routine mammogram to screen for breast cancer since she just turned 45. Under which of the following conditions will Beverly not have to pay any cost sharing? This service is not considered preventive, therefore, Beverly will have to pay cost sharing As long as Beverly receives her mammogram in-network she will have no cost sharing As long as Beverly receives her mammogram out-of-network she will have no cost sharing Which of the following statements regarding HMOs and PPOs is true? PPOs cover services rendered by providers in-network and out-of-network Premiums for PPOs are usually more expensive than HMOs HMOs only cover services rendered by in-network providers All statements are true

Answer 1

1. Beverly not have to a pay any cost sharing :

As long as Beverly recieves her mammogram in- network she will have no cost sharing.

If the healthcare provider is in contract with the your health insurance plan, he is coming under in - network. He will have prenegotiated rate. So the screening is done under such doctors, you don't have to pay.

HMOs and PPOs( Health Maintenance Organisation and Preferred Provider organisation)

True statement:

Premium for PPOs are usually more expensive than HMOs.

PPOs covers services rendered by in- networks but if a subscriber receives services out of network, then they pay their co- pay during the visit. PPO will cover only a specific percentage.

In HMO an insured person gets services from the contracted doctors, but in an emergency situation a subscriber receives urgent care then HMO may cover the expense.