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- Homework Questions & Answers
If the HMO plan is considered primary, what will Sylvia’s
portion of the charges consist of?
Ans) All medical services are provided based on a predetermined (per capita) fee and not on a fee-for-service basis. If the actual cost of services exceeds the predetermined (or capitation) amount, then the provider must absorb the excess in costs. This provides the incentive for the provider to control costs.
- A member patient must use the providers and hospitals that are identified by the HMO. The HMO will pay for any covered services that are provided by designated providers, hospitals, durable medical equipment, and pharmacies. Therefore preapproval must be granted through the PCP when and if a patient has to seek consultation or medical services out of the network. The exception to this is in the case of recognized emergency services.
An HMO plan is a capitated plan which would leave only a specific copayment amount as Mrs. Gonzales’ responsibility—which the secondary
insurance plan may pick up as part of the coordination of benefits.
If the HMO plan is considered primary, what will Sylvia’s portion of the charges consist of?
what is an HMO plan and how does it differ from PPO and POS plans in managed care organizations?
17.4 Consider the following financial statements for BestCare HMO, a not-for-profit managed care plan: BestCare HMO Statement of Operations and Change in Net Assets, Year Ended June 30, 2015 (in thousands) Revenue: Premiums earned $26,682 Coinsurance 1,689 Interest and other income 242 Total Revenues $38,613 Expenses: Salaries and benefits $15,154 Medical supplies and drugs 7,507 Insurance 3,963 Provision for bad debts 19 Depreciation 367 Interest 385 Total Expenses $27,395 Net Income $2,118 ______ BestCare...
What does a strategic plan consist of? O A. The strategies necessary to achieve the objectives and the goals to be met under the strategy OB. All of these elements stated are correct. OC. The progress to date of accomplishing the goals OD. The company's overall objectives
3) How does a member of a staff model HMO obtain coverage for a specialist, such as an oncologist? (5pts) 4) In terms of the health of populations, what type of program, supported by MCOS, stresses the habits of health lifestyles, such as exercise and proper nutrition? pts) 5) What type of physicians are generally considered primary care physicians? (5pts) 6) List two types of MCOs. Spts) 7) What is the goal of integrated delivery systems? Spts) 8) Name the...
Please check my answer tahnks :)You are Doctor who wans to join together wth other HMO doctors but not give up your individual practice what would be your best choice for doing thatI think it might be primary care physicain practice
What is the private insurance plan that was the pioneer (first & largest) and had a nonprofit status that made it unique among all private insurance carriers for many years. What were the first 2 Prepaid Group Practice Health Plans & in what state did they begin According to the Health Maintenance Organization Act of 1973 who can sponsor and operate an HMO prepaid group practice
What is the private insurance plan that was the pioneer (first & largest) and had a nonprofit status that made it unique among all private insurance carriers for many years? What were the first 2 Prepaid Group Practice Health Plans & in what state did they begin? According to the Health Maintenance Organization Act of 1973 who can sponsor and operate an HMO prepaid group practice?
Media Service charges $40 for a phone and $30 a month for its economy plan. The equation c=30t + 40. What is the cost for two months of service? If a customer has only $110 available how many months of service can she receive?
AT&T offers long distance phone plan that charges $4.95 per month plus $.07 per minute. During the course of a year, Sophia's long-distance bill ranges from $13.00 to $22.80. What was the range of monthly minutes?
What is the primary purpose of the history and physical examination? a.to assist the physician in establishing a plan of care b. to comply with Joint Commission recommendations c. to assist registration personnel with room assignment d. to begin the record in proper chronological order