Question 1

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider.

Accepted Answer

A)   participating
B)   paying
C)   physician
D)   None of the above

Question 2

A physician can choose whether to accept Medicaid patients.

Accepted Answer

A) True 
 B)False

Question 3

Which type of referral is usually processed immediately?

Accepted Answer

A)   Regular
B)   Urgent
C)   STAT
D)   All of the above

Question 4

The medical assistant should always verify which of the following prior to the patient's appointment?

Accepted Answer

A)   Eligibility
B)   Benefits and exclusions
C)   Effective date of insurance
D)   All of the above

Question 5

Which of the following managed care plans require preauthorization for medical services such as surgery?

Accepted Answer

A)   HMOs
B)   PPOs
C)   EPOs
D)   Both A and B
E)   All of the above

Question 6

Employee-sponsored group policies usually provide greater benefits at lower premiums because of the large pool of people from whom premiums are collected. However, these employee-sponsored group health insurance plans offer limited benefits, and healthcare access is limited to healthcare providers that are contracted with them.

Accepted Answer

A)   Both statements are true.
B)   Both statements are false.
C)   The first statement is true; the second is false.
D)   The first statement is false; the second is true.

Question 7

Most of today's health insurance policies cover which of the following?

Accepted Answer

A)   Preventive care
B)   Procedures deemed medically necessary
C)   Elective procedures
D)   All of the above
E)   Both A and B

Question 8

Organizations that fund their own insurance programs offer their employees

Accepted Answer

A)   group coverage.
B)   individual coverage.
C)   government plans.
D)   self-funded plans.

Question 9

Which of the following individuals would not normally be eligible for Medicare?

Accepted Answer

A)   A 66-year-old retired woman
B)   A blind teenager
C)   A 23-year-old recipient of AFDC
D)   A person on dialysis

Question 10

The amount of money paid to keep an insurance policy in force is the

Accepted Answer

A)   premium.
B)   deductible.
C)   co-pay.
D)   co-insurance.

Question 11

Nearly all of the physician's income is derived from the insurance payments received for services rendered.

Accepted Answer

A) True 
 B)False

Question 12

Which of the following are not reviewed by a utilization review committee?

Accepted Answer

A)   Physician referrals
B)   Cases of emergency department visits and urgent care
C)   Individual cases to ensure medical care services are medically necessary
D)   Fees for services provided

Question 13

Which part of Medicare covers prescription drug services?

Accepted Answer

A)   A
B)   B
C)   C
D)   D

Question 14

The amount of money the policyholder pays per claim or per accident toward the total amount of an insured loss before the company will pay on the claim is known as the

Accepted Answer

A)   exclusion.
B)   premium.
C)   deductible.
D)   remittance.

Question 15

Health insurance typically covers services and procedures considered medically necessary. Most insurance policies also cover "elective" procedures, such as certain cosmetic surgeries, that are not considered medically necessary.

Accepted Answer

A) True 
 B)False

Question 16

The TRICARE option that is similar to a preferred provider network is TRICARE

Accepted Answer

A)   Prime.
B)   Extra.
C)   Standard.
D)   Basic.

Question 17

The amount payable by an insurance company for a monetary loss to an individual insured by that company, under each coverage is called the

Accepted Answer

A)   benefits.
B)   deductible.
C)   premium.
D)   co-pay.

Question 18

The maximum amount of money third-party payers will pay for a specific procedure or service is called the

Accepted Answer

A)   benefit.
B)   allowable amount.
C)   allowed service.
D)   incurred amount.

Question 19

The federal- and state-sponsored health insurance program for the medically indigent is called

Accepted Answer

A)   Medicare.
B)   Medicaid.
C)   Medigap.
D)   MediCal.

Question 20

Dependents of military personnel are covered by which of the following government-sponsored health insurance plans?

Accepted Answer

A)   Medicaid
B)   Medicare
C)   TRICARE
D)   CHAMPVA
E)   Workers' compensation

Exam 14: Basics of Health Insurance

The amount of money the policyholder pays per claim or per accident toward the total amount of an insured loss before the company will pay on the claim is known as the

Correct Answer
verified

Most of today's health insurance policies cover which of the following?

Correct Answer
verified

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider.

Correct Answer
verified

Organizations that fund their own insurance programs offer their employees

Correct Answer
verified

The TRICARE option that is similar to a preferred provider network is TRICARE

Correct Answer
verified

A physician can choose whether to accept Medicaid patients.

Correct Answer
verified

The federal- and state-sponsored health insurance program for the medically indigent is called

Correct Answer
verified

Correct Answer
verified

Which of the following individuals would not normally be eligible for Medicare?

Correct Answer
verified

Which type of referral is usually processed immediately?

Correct Answer
verified

Which of the following managed care plans require preauthorization for medical services such as surgery?

Correct Answer
verified

Which part of Medicare covers prescription drug services?

Correct Answer
verified

The amount of money paid to keep an insurance policy in force is the

Correct Answer
verified

Nearly all of the physician's income is derived from the insurance payments received for services rendered.

Correct Answer
verified

The maximum amount of money third-party payers will pay for a specific procedure or service is called the

Correct Answer
verified

Dependents of military personnel are covered by which of the following government-sponsored health insurance plans?

Correct Answer
verified

The medical assistant should always verify which of the following prior to the patient's appointment?

Correct Answer
verified

Health insurance typically covers services and procedures considered medically necessary. Most insurance policies also cover "elective" procedures, such as certain cosmetic surgeries, that are not considered medically necessary.

Correct Answer
verified

Which of the following are not reviewed by a utilization review committee?

Correct Answer
verified

The amount payable by an insurance company for a monetary loss to an individual insured by that company, under each coverage is called the

Correct Answer
verified

Exam 14: Basics of Health Insurance

The amount of money the policyholder pays per claim or per accident toward the total amount of an insured loss before the company will pay on the claim is known as the

Correct AnswerverifiedShow Answer

Most of today's health insurance policies cover which of the following?

Correct AnswerverifiedShow Answer

The physician who enters into a contract with an insurance company and agrees to certain rules and regulations is called a ______ provider.

Correct AnswerverifiedShow Answer

Organizations that fund their own insurance programs offer their employees

Correct AnswerverifiedShow Answer

The TRICARE option that is similar to a preferred provider network is TRICARE

Correct AnswerverifiedShow Answer

A physician can choose whether to accept Medicaid patients.

Correct AnswerverifiedShow Answer

The federal- and state-sponsored health insurance program for the medically indigent is called

Correct AnswerverifiedShow Answer

Correct AnswerverifiedShow Answer

Which of the following individuals would not normally be eligible for Medicare?

Correct AnswerverifiedShow Answer

Which type of referral is usually processed immediately?

Correct AnswerverifiedShow Answer

Which of the following managed care plans require preauthorization for medical services such as surgery?

Correct AnswerverifiedShow Answer

Which part of Medicare covers prescription drug services?

Correct AnswerverifiedShow Answer

The amount of money paid to keep an insurance policy in force is the

Correct AnswerverifiedShow Answer

Nearly all of the physician's income is derived from the insurance payments received for services rendered.

Correct AnswerverifiedShow Answer

The maximum amount of money third-party payers will pay for a specific procedure or service is called the

Correct AnswerverifiedShow Answer

Dependents of military personnel are covered by which of the following government-sponsored health insurance plans?

Correct AnswerverifiedShow Answer

The medical assistant should always verify which of the following prior to the patient's appointment?

Correct AnswerverifiedShow Answer

Health insurance typically covers services and procedures considered medically necessary. Most insurance policies also cover "elective" procedures, such as certain cosmetic surgeries, that are not considered medically necessary.

Correct AnswerverifiedShow Answer

Which of the following are not reviewed by a utilization review committee?

Correct AnswerverifiedShow Answer

The amount payable by an insurance company for a monetary loss to an individual insured by that company, under each coverage is called the

Correct AnswerverifiedShow Answer

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