Question

According to Medicare and many states, which is considered a violation of a managed care plan's responsibilities?

a. adverse selection
b. self-referral
c. fee-for-service
d. gag clause

Answer 1

A gag clause is considered a violation of a managed care plan's responsibilities according to Medicare and many states, as it limits communication between healthcare providers and patients about treatment options.

Step-by-step explanation:

According to Medicare and many states, a gag clause is considered a violation of a managed care plan's responsibilities. A gag clause prohibits healthcare providers from discussing all available treatment options with patients, whether or not the plan would cover those treatments. Such restrictions can prevent patients from receiving comprehensive information about their treatment options and interfere with the doctor-patient relationship. In contrast, adverse selection, self-referral, and fee-for-service are different concepts within the healthcare insurance market. Adverse selection is related to the insurance market challenge where there is an asymmetry of information between the insurer and the insured. Self-referral occurs when a healthcare provider refers patients to facilities in which they have a financial interest. Fee-for-service is a payment model where services are unbundled and paid for separately. It is essential for healthcare providers and plans to operate ethically and in compliance with regulations to ensure patient trust and care quality.