A patient is upset because her health insurance plan refused to pay for a mammogram and services by a women's health specialist because the primary care physician did not order the referral or the mammogram
Which type of insurance plan adheres to this type of payment system?
a. Fee for Service
b. Health Maintenance Organization (HMO)
c. Preferred Provider Organization (PPO)
d. Point of Service (POS)
ANS: B
Correct: HMOs require patients to select a primary care physician approved by the HMO who then must refer or order any test/diagnostic procedures before payment is approved or preapproval must be sought.
Incorrect:
a. Fee for service allows members to choose physicians and specialists without restraint but may cover only usual or reasonable and customary charges for treatment and services, with members responsible for charges above that payment.
c. PPO plans allow members to select physicians, but pay less for physicians and facilities on the plan's preferred list.
d. POS plans allow use of providers outside plan's preferred list or network, but require higher premiums and copayments for services.
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Which steps will the nurse perform to remove a client's soft contact lens?
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