Question

instructions: select the most appropriate response.
if a health insurance plans prior approval requirements are not met by providers and the claim is submitted for reimbursement,
a. patients coverage is cancelled.
b. payment of the claim is denied.
c administrative costs are reduced.
d. they pay a fine to the health plan.

Explanation:

When a health insurance plan's prior approval requirements are not met by providers and the claim is submitted for reimbursement, the typical consequence is that the payment of the claim is denied. Cancelling patients' coverage (a) is an extreme measure not directly related to just a prior - approval - not - met situation. Administrative costs are more likely to increase due to the need to review the non - compliant claim rather than be reduced (c). Paying a fine (d) is not the standard immediate response for a claim submission without prior approval; denial of payment is the more common and direct outcome.

Answer:

B. payment of the claim is denied.