Fundamentos de Accidente y SaludPregunta 482 de 716
In an HMO, the primary care physician often serves as a 'gatekeeper,' which means the physician:
a.Sets the plan's annual deductible amount and the coinsurance percentage members owe
b.Coordinates the member's overall care and provides referrals to specialists
c.Owns and operates the HMO
d.Collects the plan's monthly premiums
Explicación
As a gatekeeper, the primary care physician manages the member's overall care and must generally provide a referral before the member sees a specialist, which helps the HMO control costs and avoid unnecessary services. The gatekeeper does not collect premiums, own the HMO, or set the deductible. The gatekeeper model is a defining feature of traditional HMOs and a key difference from PPOs, which usually let members self-refer to specialists.
Practica las 716 preguntas gratis — sin registro.
Own the complete California Life & Health Insurance Producer Exam guide — PDF + EPUB, $19.99 →
Preguntas relacionadas de este tema
- The term 'usual, customary, and reasonable' (UCR) charge refers to:
- A managed care 'preauthorization' (precertification) requirement means the insured or provider must:
- Under a 'capitation' payment arrangement, an HMO pays a network physician:
- A Point-of-Service (POS) health plan is best described as:
- Many disability income policies include a waiver of premium feature that:
- Under a 'guaranteed renewable' health policy, the insurer:
Última revisión: · proceso editorial
Equipo de PrepPass · Verificado con California Life & Health Insurance License Exam · Cómo revisamos
Revisado por John Zihao Zhang — California-Licensed Life Insurance Agent (CA Dept. of Insurance License #4396095 — verificar)