Câu 23: AHM-530: Network Management

The Gardenia Health Plan has a national reputation for quality care. When Gardenia entered a new market, it established a preferred provider organization (PPO), a health maintenance organization (HMO), and a point-of-service product (POS) to serve the plan members in this market. All of the providers included in the HMO or the POS are included in the broader provider panel of the PPO. The POS will be a typical two-level POS that offers a cost-based incentive plans for PCPs, and the HMO is a typical staff model HMO. One statement that can correctly be made about Gardenia's two-level POS product is that:

1. A. members who self-refer without first seeing their PCPs will receive no benefits
2. B. both Gardenia and the PCPs stand to benefit if the non-provider panels are kept relatively narrow
3. C. members will pay higher coinsurance or copayments if they first see their PCPs each time
4. D. the plan offers no financial incentives to members to choose an in-network specialist over a non-network specialist — đáp án hiện tại