Cơ bản về Tai nạn & Sức khỏeCâu 480 / 716
A managed care 'preauthorization' (precertification) requirement means the insured or provider must:
a.File a written police report with local law enforcement before any medical treatment is received
b.Obtain the plan's approval before certain services, such as a non-emergency hospital admission, to ensure coverage
c.Wait a full year after enrolling in the plan before receiving benefits for any hospital service
d.Pay the entire hospital bill up front before any care is delivered and then submit the itemized receipts for reimbursement
Giải thích
Preauthorization (precertification) requires that the plan review and approve certain non-emergency services, such as a planned hospital stay or a costly procedure, before they are provided, both to confirm medical necessity and to ensure the service will be covered. It is not a requirement to pay the full bill first, to wait a year, or to file a police report. Managed care plans use preauthorization to control costs and steer care to appropriate settings.
Luyện miễn phí toàn bộ 716 câu hỏi — không cần đăng ký.
Own the complete California Life & Health Insurance Producer Exam guide — PDF + EPUB, $19.99 →
Câu hỏi liên quan cùng chủ đề
- Contributions to a Health Savings Account (HSA) generally receive which federal tax treatment?
- Unlike a Flexible Spending Account (FSA), unused funds in a Health Savings Account (HSA) at year-end:
- The term 'usual, customary, and reasonable' (UCR) charge refers to:
- Under a 'capitation' payment arrangement, an HMO pays a network physician:
- In an HMO, the primary care physician often serves as a 'gatekeeper,' which means the physician:
- A Point-of-Service (POS) health plan is best described as:
Cập nhật gần nhất: · quy trình kiểm tra
Đội ngũ PrepPass · Đối chiếu với California Life & Health Insurance License Exam · Quy trình kiểm tra
Người kiểm duyệt John Zihao Zhang — California-Licensed Life Insurance Agent (CA Dept. of Insurance License #4396095 — kiểm tra)