QUESTION: 109

Lansdale Healthcare, a health plan, offers comprehensive healthcare coverage to its members through a network of physicians, hospitals, and other service providers. Plan members who use in- network services pay a copayment for these services. The copayment

specified dollar amount charge that a plan member must pay out-of-pocket for a specified medical service at the time the service is rendered
percentage of the fees for medical services that a plan member must pay after Magellan has paid its share of the costs of those services
flat amount that a plan member must pay each year before Magellan will make any benefit payments on behalf of the plan member
specified payment for services that was negotiated between the provider and Magellan

Answer(s): A

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QUESTION: 110

Managed behavioral health organizations (MBHOs) use several strategies to manage the delivery of behavioral healthcare services. The following statements are about these strategies. Select the answer choice that contains the correct statement.

MBHOs generally provide benefits for mental health services but not for chemical dependency services.
The level of care needed to treat behavioral disorders is the same for all patients and all disorders.
By using outpatient treatment more extensively, MBHOs have decreased the use of costly inpatient therapies.
PCP gatekeeper systems for behavioral healthcare generally result in more accurate diagnoses, more effective treatment, and more efficient use of resources than do centralized referral systems.

Answer(s): C

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QUESTION: 111

Many HMOs are compensated for the delivery of healthcare to members under a prepaid care arrangement. Under a prepaid care arrangement, a plan member typically pays a

fixed amount in advance for each medical service the member receives
a small fee such as $10 or $15 that a member pays at the time of an office visit to a network provider
a fixed, monthly premium paid in advance of the delivery of medical care that covers most healthcare services that a member might need, no matter how often the member uses medical services
specified amount of the member's medical expenses before any benefits are paid by the HMO

Answer(s): C

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QUESTION: 112

Many of the credentialing standards and criteria used by health plans are often taken from already existing standards established by

the National Practitioner Data Bank (NPDB)
the National Association of Insurance Commissioners (NAIC)
the Centers for Medicare and Medicaid Services (CMS)
independent accrediting organizations

Answer(s): D

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QUESTION: 109

QUESTION: 110

QUESTION: 111

QUESTION: 112