Question 1

In exchange for the premium that the policyholder pays, the health plan agrees to pay amounts for medical services called _______.

Accepted Answer

In exchange for the premium that the policyholder pays, the health plan agrees to pay amounts for medical services called benefits.

Question 2

___________ is the percentage of the charges an insured person must pay for health care services after the deductible has been met.

Accepted Answer

Coinsurance is the percentage of charges an insured person must pay for health care services after the deductible. The coinsurance rate state the amount the health plan percentage of the charge followed by the insured's percentage, such as 80/20

Question 3

Coinsurance is paid by the ______.

Accepted Answer

Coinsurance is paid by the policyholder.

Question 4

______ is the amount that a person insured in a managed care plan must pay for each office visit.

Accepted Answer

The amount that a person insured in a managed care plan must pay for each office visit is called the copayment.

Question 5

Cost-containment practices are designed to __________.

Accepted Answer

Most health care plans have cost containment practices to help control prices.

Question 6

_____ is the amount the insured must pay before receiving benefits from the insurance policy.

Accepted Answer

The amount that the insured pays on covered services before benefits begin is called a deductible. This must have been met (paid) for benefits to begin. Deductibles range widely, usually from $200 to thousands of dollars annually. Higher deductibles generally mean lower premiums.

Question 7

A person who is also covered under an insured person's policy is called a(n) ______.

Accepted Answer

A dependent is a person who is covered under a insured policy in addition to the policyholder.

Question 8

A provider's analysis of a patient's illness or injury is called ____.

Accepted Answer

The diagnosis is the physician's findings of the nature of the patient's illness or injury.

Question 9

____ is a health plan document that provides details about how a patient's claim was handled.

Accepted Answer

A remittance advice lists the transactions included on the claims, states the amount paid, and provides an explanation of any charges that were not paid in full or were denied entirely.

Question 10

_____ are benefits paid based on the fees physician charge for the services.

Accepted Answer

Fee-for-service is benefits that are paid based on the fees physicians charge for the services.

Question 11

______ is a formal insurance claim, either electronic or hard copy format, which is filed with the payer (insurance carrier) by many medical offices on behalf of their patients to receive payments.

Accepted Answer

Health Care Claim is a formal insurance claim in either electronic or hard copy format that reports data about the patient and the services provided by the physician-to the payer on behalf of the patient to receive payments.

Question 12

____ are organizations that offer financial protection in case of illness or accidental injury.

Accepted Answer

Health plans, also called insurance companies, are organizations that offer financial protection in case of illness or accidental injury.

Question 13

___ are organizations that offer health plans that combine the financing and delivery of health care services.

Accepted Answer

Managed care is a way of supervising medical care with the goal of ensuring that patients get needed services in the most appropriate, cost-effective setting by combining the financing and delivery of health care services.

Question 14

___ is a financial plan that covers the cost of hospitalization and medical care due to illness or injury.

Accepted Answer

Medical insurance is a financial plan that covers the cost of hospital and medical care.

Question 15

____ is a form that contains demographic information about a patient.

Accepted Answer

A patient information form includes the patient's demographic data.

Question 16

____ is a person who buys an insurance plan.

Accepted Answer

The policyholder is a person who buys an insurance plan.

Question 17

When a health plan has approved a procedure before it is done, this process is called____.

Accepted Answer

When a health plan approves a procedure before it is done in order for the procedure to be covered, this process is called preauthorization.

Question 18

A _____ is a person or entity that supplies medical or health services.

Accepted Answer

A provider is a person or entity that supplies medical or health services.

Question 19

A list of covered services that an insurance policy covers is called ____.

Accepted Answer

The health plan issues the policyholder a list that contains covered services called a schedule of benefits.

Question 20

___ are medical procedures and treatments included as benefits in a health plan.

Accepted Answer

Covered services are medical procedures and treatments included as benefits in a health plan.

Quiz 1: From Patient to Payment Understanding Medical Insurance