Question

if an enrollee seeks health care services from a non - managed care panel specialist without a referral from the primary care physician, this is known as a(n)
a. fee - for - service.
b. adverse selection.
c. self - referral.
d. risk contract.

Explanation:

Self - referral occurs when an enrollee accesses a specialist without a referral from the primary care physician. Fee - for - service is a payment model. Adverse selection is about risk in insurance. Risk contract is related to financial risk in healthcare contracts.

Answer:

C. self - referral.