Question

An inpatient undergoes a procedure and has a postoperative complication during the hospitalization. The insurance company will not pay for the entire amount requested. Which POA indicator is likely part of the cause?

-N
-Y
-W
-U

Answer 1

The POA indicator "N" is likely part of the cause for the insurance company not paying the entire amount. Moral hazard and adverse selection are related concepts in insurance and healthcare. Medicare, Medicaid, ACA, and fee-for-service are important healthcare terms.

Step-by-step explanation:

The POA indicator that is likely part of the cause for the insurance company not paying for the entire amount is "N" which stands for "Not Available." It indicates that the information regarding the patient's condition at the time of admission is not available. This lack of information may lead to the insurance company denying coverage for the postoperative complication.

Moral hazard and adverse selection are concepts related to insurance and healthcare. Moral hazard refers to the increased risk-taking behavior of insured individuals when they have insurance coverage, potentially leading to higher costs for insurers. Adverse selection occurs when individuals with higher risk seek out insurance coverage more than those with lower risk, leading to an imbalance in costs.

In the context of healthcare, Medicare and Medicaid are government programs that provide health insurance coverage for certain populations. The Patient Protection and Affordable Care Act (ACA or Obamacare) is a federal law aimed at expanding access to healthcare and regulating the health insurance industry. Fee-for-service is a payment model where healthcare providers are reimbursed for each service they provide.