SOLVED

71. When a concurrent review determines that the patient no longer requires services, who determines when the patient will be discharged? a.The physician b.The plan administrator c.The patient d.The discharge planner 72. If a physician disagrees with a concurrent review and keeps the patient in the hospital longer, what is likely to happen with the insurance company? a.The physician will be removed from participation in the insurance program. b.The patient may be liable to pay out of pocket for the uncertified days. c.The insurance company will have to reconsider their opinion. d.The hospital will get involved to make sure the physician is paid. 73. What is the downside to a retrospective review? a.The patient has already had the procedure. b.The physician has already been paid. c.The patient and physician are not notified until after the procedure that the insurance will not cover said procedure. d.The hospital uses the information to raise costs. 74. What is the purpose of a second opinion related to surgical recommendations? a.To determine if the surgery is medically necessary b.To give the patient a chance to change his or her mind c.To delay the surgery d.To find evidence that the patient doesn’t really need the surgery 75. If there is a mandatory second opinion on surgery as part of the insurance contract, the patient who does not get a second opinion may: a.have to get one the day of surgery. b.be dropped from the insurance program. c.be subject to penalties or decreased payment for the surgery. d.be stuck with the entire bill for the surgery. 76. What factor influences one surgeon NOT to want to offer an opinion different from that of another surgeon? a.That they are in competition b.Because they are friends c.Because there are so many malpractice lawsuits towards one who differs in a second opinion d.The worry about losing one’s employment. 77. To determine the order of benefits paid involving two insurance plans, the plan without a COB provision is always: a.secondary. b.tertiary. c.primary. d.None of the above 78. If an individual is insured under his or her employer’s insurance plan and the employee is also covered under his or her spouse;s insurance, what decides the order of benefit determination? a.Whichever policy was in place first is primary. b.Whichever policy is government regulated is primary. c.Whichever policy is primary for the insured is the primary payer. d.Whichever policy has stipulations to always being secondary will be secondary. 79. If a child is covered under both married parents’ insurance policies, the primary plan is determined by: a.the birth date of the child. b.the birth dates of the parents. c.the marriage date of the parents. d.the year the child was born. 80. In cases of legally separated or divorced parents both having coverage on a child, the primary insurance is determined by: a.the birth dates of the parents. b.the person with whom the child lives for the majority of time. c.the person legally responsible for health care insurance. d.the person who initiated the divorce.