CBCS Health Insurance 1

Question 1

What is coinsurance in a health insurance policy?

Accepted Answer

A percentage of the cost of a covered healthcare service that the patient pays after the deductible has been met

Answer

A fixed amount the patient pays for a covered healthcare service

Answer

The total cost of the healthcare service covered by insurance

Answer

The amount the insurance company pays for a covered healthcare service

Question 2

How are claims typically handled in an indemnity health insurance plan?

Accepted Answer

The patient pays the healthcare provider upfront and then files a claim for reimbursement

Answer

The healthcare provider bills the insurance company directly, and the patient pays nothing

Answer

The patient and provider share the cost equally

Answer

The insurance company pays the provider directly and sends a bill to the patient

Question 3

What is the typical payment structure for providers in an HMO?

Accepted Answer

Capitation

Answer

Fee-for-service

Answer

Pay-for-performance

Answer

Retainer fee

Question 4

What does "underpayment" refer to in the context of medical billing and coding?

Accepted Answer

When the insurance company pays less than the billed amount

Answer

When the insurance company pays more than the billed amount

Answer

When the patient pays more than the copay amount

Answer

When the billed amount is adjusted for a contractual agreement

Question 5

Which insurance plan type requires members to choose a primary care physician (PCP) and get referrals to see specialists?

Accepted Answer

HMO

Answer

PPO

Answer

POS

Answer

EPO