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Insurance companies will only pay costs when a procedure is deemed medically necessary. By medically necessary, they mean
- A. the procedure has to be a reasonable intervention, given the patient's diagnosis.
- B. the patient has to want to have the procedure done.
- C. the procedure has to treat an illness or injury.
- D. the procedure must contribute to the patient's sense of well-being.
Correct Answer: A,C
Rationale: Medically necessary procedures are reasonable interventions that treat an illness or injury.
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Health care provided by various companies and purchased by the individual or an employer is called
- A. Medicare.
- B. Medicaid.
- C. managed care.
- D. private insurance.
Correct Answer: D
Rationale: Private insurance is purchased by individuals or employers, unlike government programs.
Fill in the blank with the correct Key Term(s) or italicized words from your text: A facility that specializes in intense physical, occupational, and speech therapy is called a(n) ___ facility.
- A. Hospice
- B. Home health
- C. Rehabilitation
- D. Skilled nursing
Correct Answer: C
Rationale: A rehabilitation facility specializes in intensive physical, occupational, and speech therapy.
Explain why patients should know the details of their insurance plans.
- A. To understand coverage limits and out-of-pocket costs.
- B. To ensure they receive necessary treatments.
- C. To avoid unexpected medical bills.
- D. To coordinate care with providers.
Correct Answer: A,C
Rationale: Knowing insurance details helps patients manage costs and avoid unexpected bills.
Primary care must be performed by an RN.
- A. TRUE
- B. FALSE
Correct Answer: B
Rationale: Primary care nursing can be performed by various nursing levels, not only RNs.
Fill in the blank with the correct Key Term(s) or italicized words from your text: When a person stays overnight or longer in a healthcare facility, he or she is referred to as a(n)
- A. Inpatient
- B. Outpatient
- C. Resident
- D. Client
Correct Answer: A
Rationale: An inpatient is someone who stays overnight or longer in a healthcare facility.