QUESTION: 121

More procedures or services may be fully covered within the PPO network than those out of network.

True
False

Answer(s): A

Most contracts between health plans and providers contain a provision which forbids providers from seeking compensation from patients if the health plan fails to compensate the provider because of insolvency or for any other reason. Such a provision is kn

due process provision
cure provision
hold-harmless provision
risk-sharing provision

Answer(s): C

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QUESTION: 123

Mr. George Bush is covered by a PBM plan that uses a closed formulary. This indicates that

he can receive coverage for pharmaceuticals only if they are on the PBM plan's preferred list of drugs
he must receive all of his pharmaceuticals from a mail-order pharmacy program
he can receive coverage for pharmaceuticals that are on the PBM plan's preferred list of drugs, as well as for pharmaceuticals that are not on the preferred list
the PBM plan cannot receive a rebate on any pharmaceuticals it obtains from the pharmaceutical facture

Answer(s): A

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QUESTION: 124

Natalie Chan is a member of the Ultra Health Plan, a health plan.
Whenever she needs nonemergency medical care, she sees Dr. David Craig, an internist. Ms. Chan cannot self-refer to a specialist, so she saw Dr. Craig when she experienced headaches. Dr. Cr

Within Ultra's system, Ms. Chan received primary care from both Dr. Craig and Dr. Lee
Ultra's system allows its members open access to all of Ultra's participating providers.
Within Ultra's system, Dr. Craig serves as a coordinator of care or gatekeeper for the medical services that Ms. Chan receives.
Ultra's network of providers includes Dr. Craig and Dr. Lee but not Arrow Hospital

Answer(s): C

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Free AHM-250 Exam Braindumps (page: 32)

QUESTION: 121

QUESTION: 122

QUESTION: 123

QUESTION: 124

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