199k views
4 votes
An HMO is required to provide the member with inpatient hospital care inside or outside of the service area for at least how many days per year for the treatment of each injury or sickness.

a. true
b. false

User ArcherBird
by
8.7k points

1 Answer

2 votes

Final answer:

The requirement for an HMO to provide inpatient care for a minimum number of days is not a standard rule and can vary based on the specific HMO policy and regulations. In contrast, fee-for-service plans pay per service without preset coverage limits.

Step-by-step explanation:

The statement about an HMO (Health Maintenance Organization) being required to provide a member with inpatient hospital care for a minimum number of days per year for each injury or sickness is not universally true or false without specific context. HMO benefits and coverage, including inpatient care coverage, can vary significantly based on individual HMO policies, state laws, and federal regulations. Coverage for inpatient care typically includes a defined number of days for treatment, but these specifics are detailed in each HMO's plan documents. Whereas, fee-for-service plans would pay for services as they are provided without a preset limit.

In contrast, a fee-for-service health financing system reimburses medical care providers based on each service they provide, without a set limit on the number of days of coverage. HMOs typically operate under a capitated payment system where they receive a fixed amount per patient enrolled, regardless of the number of services provided.

User Aaronb
by
8.4k points