Health Insurance Basic Questions

Multiple Questions

1. Mrs. Washington was involved in a traffic accident. She saw Dr. Grace because of pain in her right knee. She explained that this pain was the result of her knee hitting the dashboard on impact. Mrs. Washington has a history of arthritis in both of her knees. Dr. Grace listed her diagnosis from this visit as bilateral degenerative joint disease. What are the consequences of this diagnosis on Mrs. Washington’s case?

2. Anthony is 17 years of age and attending college in Maine. One day while skiing he broke his leg and was taken to the emergency room of the local hospital. When filling out the necessary paperwork, whom should Anthony name as the party responsible for the charges incurred?

3. Mrs. Cassidy called her physician’s office complaining that her insurance company was billed twice for her office visit on November 19. Carole pulled Mrs. Cassidy’s file and verified that this was true. She apologized for the error and assured Mrs. Cassidy that she would correct this error. What steps should be taken to avoid duplicate billing

4. Mrs. Ellison called her doctor’s office and spoke with Lorraine about a bill from her recent visit. Mrs. Ellison has been Dr. Johnson’s patient for many years, although prior to her recent visit it had been some time since she saw Dr. Johnson. Mrs. Ellison was sure that there was a billing error because she was billed for a new patient visit. How should Lorraine handle this patient’s inquiry

5. Allison was working at the reception desk during a department staff meeting. She normally worked in medical records and therefore had an understanding of the importance of patient confidentiality. When a caseworker from a workers’ compensation case arrived and asked to discuss a patient’s case with the physician, Allison explained that she would need a signed release form from the patient before that was possible. Did Allison handle this situation correctly?

6. Jamie is reviewing Mr. Murphy’s medical file to process his insurance claim. She has difficulty reading the doctor’s notes, but rather than flag the file to check with the doctor, Jamie makes an educated guess and completes the insurance form. What are some possible consequences of Jamie’s actions.

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