Question

A doctor who agrees to accept an insurance company's pre-established fee as the maximum amount to be collected is called______________?

1) Subscriber
2) Claim representative
3) Participating physician
4) Adjuster

Answer 1

A doctor who accepts an insurance company's pre-established fee is known as a participating physician, which helps manage costs and combat adverse selection in insurance markets.

Step-by-step explanation:

A doctor who agrees to accept an insurance company's pre-established fee as the maximum amount to be collected is called a participating physician. This approach is common in health care delivery systems like Health Maintenance Organizations (HMOs). Participating physicians typically enter into agreements with insurance providers to accept the pre-determined fees for services delivered to insured patients. This system helps to manage costs and can prevent instances of adverse selection, which occurs when insurance buyers have more information about their health risks than the insurance company, leading to potential financial discrepancies for the insurer.