Question

multiple choice question

who is responsible for payment when the health plan does not allow for out-of-network benefits?

• the health plan
• the spouse
• the patient
• the parent

Explanation:

Analyze out-of-network coverage rules

Using the Noncovered Services knowledge point, when a health insurance plan does not allow or cover out-of-network benefits, any care received from an out-of-network provider is considered a noncovered service. The insurance plan will not pay for these services.

Determine financial liability

Using the Patient Financial Responsibility knowledge point, if a health plan denies payment because a service is not covered or is out-of-network, the ultimate financial liability falls on the individual receiving the care. Therefore, the patient is responsible for the payment.

Answer:

• The health plan
• The spouse
• The patient (Correct answer)
• The parent