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AHM-250 Exam Dumps : Healthcare Management: An Introduction

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Healthcare Management: An Introduction Questions and Answers

Question 1

Phillip Tsai is insured by both a indemnity health insurance plan, which is his primary plan, and a health plan, which is his secondary plan. Both plans have typical coordination of benefits (COB) provisions, but neither has a nonduplication of benefits p

Options:

A.

$0

B.

$300

C.

$400

D.

$900

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Question 2

Several marketplace factors helped fuel the movement toward consumer choice. Which one of the following statements is NOT accurate with regard to these factors?

Options:

A.

After a period of relative stability, annual growth in private health spending per capita began to increase rapidly in 2002.

B.

During the height of the recent cost upswing, insurance premiums were increasing by more than 13% annually.

C.

Increased utilization was the largest factor contributing to the rise in premiums, accounting for 43% of the increase.

D.

Employer payers began seeking ways to control spiraling utilization rates and provide lower cost health coverage options.

Question 3

If left unresolved, member complaints about the actions or decisions made by a health plan or its providers can lead to formal appeals. One procedure health plans can use to address formal appeals is to submit the original decision and any supporting info

Options:

A.

A Level One appeal, and the member has the right to a further appeal

B.

A Level Two appeal, and the reviewer's decision is final and binding

C.

An independent external appeal, and the member has the right to a further appeal

D.

Arbitration, and the reviewer's decision is final and binding