Understanding Health Insurance

Health & Kinesiology

Quiz 13 :
Bluecross Blueshield

Quiz 13 :
Bluecross Blueshield

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The forerunner of what is known today as the BlueCross plan began in 1929 when Baylor University Hospital in Dallas, Texas, approached teachers in the Dallas school district with a plan that would guarantee up to 21 days of hospitalization per year for subscribers and each of their dependents, in exchange for a $6 annual premium. This was considered a __________ plan.
Free
Multiple Choice
Answer:

Answer:

B

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By 1932 some plans modified the prepaid plan concept and organized community-wide programs that allowed the subscriber to be hospitalized in one of several member hospitals in accordance with signed contracts to provide services __________.
Free
Multiple Choice
Answer:

Answer:

B

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BlueShield plans were created as the result of a resolution passed by the House of Delegates at an American Medical Association meeting in 1938. This resolution supported the concept of __________ health insurance that would encourage physicians to cooperate with prepaid health care plans.
Free
Multiple Choice
Answer:

Answer:

D

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BlueCross plans originally covered only hospital bills, and BlueShield plans covered fees for physician services, and there was close cooperation between the plans that resulted in joint ventures where the two corporations were housed in one building. In these joint ventures, BlueCross BlueShield (BCBS) __________.
Multiple Choice
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Nonprofit corporations are charitable, educational, civic, or humanitarian organizations whose profits are __________.
Multiple Choice
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For-profit corporations pay taxes on profits generated by the corporation's enterprises and pay dividends to __________ on after-tax profits.
Multiple Choice
Answer:
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Participating providers contract to participate in a BCBS plan's preferred provider network (PPN), which is a program that requires providers to adhere to __________ care provisions.
Multiple Choice
Answer:
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BCBS fee-for-service __________ coverage includes minimum benefits, such as inpatient hospitalizations and diagnostic laboratory services.
Multiple Choice
Answer:
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BCBS fee-for-service __________ coverage includes additional benefits, such as office visits, physical and occupational therapy, and mental health encounters.
Multiple Choice
Answer:
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Some BCBS contracts also include one or more riders, which are special clauses that stipulate additional coverage __________ the standard contract.
Multiple Choice
Answer:
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The BCBS special accidental injury rider covers nonsurgical care sought and rendered within 24 to 72 hours of the accidental injury, depending on plan benefits. Surgical care is subject to any established contract __________ plan deductibles and copayments.
Multiple Choice
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The medical emergency care rider covers __________ treatment sought and received for sudden, severe, and unexpected conditions that if not treated would place the patient's health in permanent jeopardy or cause permanent impairment or dysfunction of an organ or body part.
Multiple Choice
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BCBS indemnity coverage offers choice and flexibility to subscribers who want to receive a full range of benefits along with the __________.
Multiple Choice
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The BCBS coordinated home health and hospice care program allows patients with this option to elect an alternative to __________ or long-term care settings.
Multiple Choice
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The BCBS outpatient pretreatment authorization plan (OPAP) requires preauthorization of outpatient physical, occupational, and speech therapy services. Other terms for OPAP include precertification and __________ authorization.
Multiple Choice
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The BCBS PPO plan is sometimes described as a subscriber-driven program, and BCBS substitutes the term subscriber or __________ for policyholder.
Multiple Choice
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BCBS has a mandatory second surgical opinion (SSO) requirement necessary when a patient is considering elective, nonemergency surgical care. The initial surgical recommendation must be made by a physician qualified to perform the anticipated surgery. If a second surgical opinion is not obtained prior to surgery, the patient's out-of-pocket expenses may be __________.
Multiple Choice
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The BlueCross BlueShield Federal Employee Program (FEP) is a(n) __________ health benefits program established by an Act of Congress in 1959.
Multiple Choice
Answer:
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FEP cards contain the phrase __________ under the BCBS trademark.
Multiple Choice
Answer:
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BCBS corporations offer several federally designed and regulated Medicare supplemental plans that augment the Medicare program by paying for Medicare deductibles and copayments. These plans are usually identified by the word __________ on the patient's plan ID card.
Multiple Choice
Answer:
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