QUESTION: 25

Ashley Martin is covered by a managed healthcare plan that specifies a $300 deductible and includes a 30% coinsurance provision for all healthcare obtained outside the plan's network of providers. In 1998, Ms. Martin became ill while she was on vacation,

$300
$510
$600
$810

Answer(s): D

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QUESTION: 26

Bart Vereen is insured by both a traditional indemnity health insurance plan, which is his primary plan, and a managed care plan. Both plans have a typical coordination of benefits (COB) provision, but neither plan has a nonduplication of benefits provision

380
130
0
550

Answer(s): A

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QUESTION: 27

Because many patients with behavioral health disorders do not require round-the-clock nursing care and supervision, behavioral healthcare services can be delivered effectively in a variety of settings. For example, post-acute care for behavioral health di

Hospital observation units or psychiatric hospitals.
Psychiatric hospitals or rehabilitation hospitals.
Subacute care facilities or skilled nursing facilities.
Psychiatric units in general hospitals or hospital observation units.

Answer(s): C

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QUESTION: 28

Before an HMO contracts with a physician, the HMO first verifies the physician's credentials. Upon becoming part of the HMO's organized system of healthcare, the physician is typically subject to

both recredentialing and peer review
recredentialing only
peer review only
neither recredentialing nor peer review

Answer(s): C

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QUESTION: 25

QUESTION: 26

QUESTION: 27

QUESTION: 28