AHIP AHIP Certifications AHM-250 Questions & Answers

• Question 231:

  Phoebe Urich is covered by a traditional indemnity health insurance plan that specifies a $500 calendar-year deductible and includes a 20% coinsurance provision. When Ms. Urich was hospitalized, she incurred $3,000 in medical expenses that were covered by

  A. 1900

  B. 2000

  C. 2400

  D. 2500

  Correct Answer: B

• Question 232:

  Managed behavioral health organizations (MBHOs) use several strategies to manage the delivery of behavioral healthcare services. The following statements are about these strategies.

  Select the answer choice that contains the correct statement.

  A. MBHOs generally provide benefits for mental health services but not for chemical dependency services.

  B. The level of care needed to treat behavioral disorders is the same for all patients and all disorders.

  C. By using outpatient treatment more extensively, MBHOs have decreased the use of costly inpatient therapies.

  D. PCP gatekeeper systems for behavioral healthcare generally result in more accurate diagnoses, more effective treatment, and more efficient use of resources than do centralized referral systems.

  Correct Answer: C

• Question 233:

  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 price

  A. $0

  B. $300

  C. $400

  D. $900

  Correct Answer: C

• Question 234:

  The Fairway Health Group contracted with the Empire Corporation to provide behavioral healthcare services to Empire employees. As a condition of providing behavioral healthcare services, Fairway required Empire to contract with Fairway for basic medical so

  A. horizontal group boycott

  B. price-fixing agreement

  C. horizontal division of markets

  D. tying arrangement

  Correct Answer: D

• Question 235:

  One of the distinguishing characteristics of healthcare marketing is that many of the markets for health plans are national, not local markets.

  A. True

  B. False

  Correct Answer: B

• Question 236:

  PBM plans operate under several types of contractual arrangements. Under one contractual arrangement, the PBM plan and the employer agree on a target cost per employee per month. If the actual cost per employee per month is greater than the target cost, to

  A. fee-for-service arrangement

  B. risk sharing contract

  C. capitation contract

  D. rebate contract

  Correct Answer: B

• Question 237:

  Members who qualify to participate in a health plan's case management program are typically assigned a case manager. During the course of the member's treatment, the case manager is responsible for

  A. Coordinating and monitoring the member's care

  B. Approve

  C. Both A and B

  D. A only

  E. B only

  F. Neither A nor B

  Correct Answer: B

• Question 238:

  The application of health plan principles to workers' compensation insurance programs has presented some unique challenges because of the differences between health plan for traditional group healthcare and workers' compensation. One key difference is that

  A. limits coverage to eligible employees and excludes part-time employees

  B. specifies an annual lifetime benefit maximum on dollar coverage for medical costs

  C. provides benefits regardless of the cause of an injury or illness

  D. provides benefits for both healthcare costs and lost wages

  Correct Answer: D

• Question 239:

  The following sentence contains an incomplete statement with two missing words. Select the answer choice that contains the words that correctly fill the two blanks, respectively. The philosophy of consumer choice involves having consumers play a(n) ______

  A. Decreased ... Increased

  B. Increased ... Decreased

  C. Increased ... Increased

  D. Decreased ... Decreased

  Correct Answer: C

• Question 240:

  Katrina Lopez is a claims analyst for a health plan that provides a higher level of benefits for services received in-network than for services received out-of-network. Ms. Lopez reviewed a health claim for answers to the following questions:

  A. A, B, C, and D

  B. A, B, and D only

  C. B, C, and D only

  D. A and C only

  Correct Answer: A