Question

What does a positive coverage policy indicate?

1) The payer has partnered with the provider at a contracted rate
2) The payer has not partnered with the provider
3) The payer will pay the provider based on the service provided
4) The payer will not pay the provider for the service

Answer 1

The correct answer is option 3) The payer will pay the provider based on the service provided.

Step-by-step explanation:

A positive coverage policy indicates that the insurance company, also known as the payer, will reimburse the healthcare provider for the services rendered to a patient. Specifically, it refers to scenario three: The payer will pay the provider based on the service provided.

This can take place in a fee-for-service health financing system where providers are paid for each service they perform, or within managed care organizations like HMOs (Health Maintenance Organizations).

However, terms such as deductibles, copayments, and coinsurance are important to consider as they define the out-of-pocket expenses a policyholder is responsible for before insurance coverage fully kicks in.