Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit that included some services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him?

Answers

Answer 1

Answer:

The correct answer is - You can offer to review the plan's appeal process to help him ask the plan to review the coverage decision.

Explanation:

Mr. Barker received the bill and there is an excess of the maximum out-of-pocket limit that is a limit a person has to pay for covered medical care services.

As he asked what he could do, you could explain that there are several plans he could review all the plans appeal process and to as well help him to ask the issue, benefits of each plan to review. Explaining and reviewing plans and coverage will help a person to makes decisions about their benefits including the amount they have to pay for their medical services plan.


Related Questions

Another form of fibrous connective tissue of the body that covers, connects or supports other tissues is called?

Answers

Fibrous connective tissues (figure 1) are the most diverse type of connective tissue. They are also called fibroconnective tissue or connective tissue proper. Reticular fibers are the third type of protein fiber found in connective tissues. This fiber consists of thin strands of collagen that form a network of fibers to support the tissue and other organs to which it is connected.

How to calculate the heart rate from the electrocardiogram ?​

Answers

Answer:

ECG paper is a grid where time is measured along the horizontal axis.

Each small square is 1 mm in length and represents 0.04 seconds.

Each larger square is 5 mm in length and represents 0.2 seconds.

Voltage is measured along the vertical axis.

10 mm is equal to 1mV in voltage.

The diagram below illustrates the configuration of ECG graph paper and where to measure the components of the ECG wave form

Heart rate can be easily calculated from the ECG strip:

When the rhythm is regular, the heart rate is 300 divided by the number of large squares between the QRS complexes.

For example, if there are 4 large squares between regular QRS complexes, the heart rate is 75 (300/4=75).

The second method can be used with an irregular rhythm to estimate the rate. Count the number of R waves in a 6 second strip and multiply by 10.

For example, if there are 7 R waves in a 6 second strip, the heart rate is 70 (7x10=70).

Mr. C. is at the grocery store, his niece told him to buy whole grain bread. All of the following statements are true about whole grains products EXCEPT:________
A. Any flour made from the endosperm of the wheat kernel is called wheat flour.
B. Whole grain products contain germ and bran as well asendosperm.
C. Refined-grain products contain germ and bran as well as endosperm.
D. Enriched white flour refers to refined flour.

Answers

The statement given is true except "Refined-grain products contains germ and bran as well as endosperm".

It should be noted that the wheat flour is made from the endosperm of the wheat kernel. Also, the germ, bran, and endosperm are contained in the whole grain.

The refined grain doesn't contain germ or bran because they're removed during the processing. It only contains the endosperm.

In conclusion, the correct option is C.

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A 56 year old woman is complaining of vaginal dryness and dyspareunia. She is prescribed this medicine with lesser side effects

Answers

Answer:

osphena (ospemifene)

Explanation:

Osphena would be my guess

The nurse provides dietary instructions to a client with diabetes mellitus regarding the prescribed diet. Which statement if made by the client indicates a need fir further teaching

Answers

Answer:

A nurses caring for a client after a thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medicine has been prescribed to

treat hypoglycemic tetany.

If a person’s diet includes a lot of processed foods and not a lot of fresh fruits or vegetables, failing to meet recommended intakes of ______ is likely.

Answers

Answer:

potassium

Explanation:

Got it right on the test.

If a person's diet consists primarily of processed foods and not a lot of fresh fruit and vegetables, he or she is more likely to fall short of meeting recommended potassium intakes, as fresh foods are high in potassium.

What are the roles of the ions in the body?

The ions' role is important for the body as they maintain equilibrium in the body and there are many ions such as sodium, potassium, calcium, chloride, etc., and if an ionic imbalance is attained in the body, many diseases are seen and the body's homeostasis is affected. In general, eating green vegetables and natural foods balances the ions, whereas eating processed foods creates an imbalance due to the high sodium content of preservative products.

Hence, if a person's diet consists primarily of processed foods and not a lot of fresh fruit and vegetables, he or she is more likely to fall short of meeting recommended potassium intakes, as fresh foods are high in potassium.

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The question is incomplete; the complete question is below.

If a person's diet includes a lot of processed foods and not a lot of fresh fruits or vegetables, failing to meet recommended intakes of _____ is likely. 

A. Sodium 

B. Chloride 

C. Potassium 

D. Calcium

Cholesterol is necessary for the production of many other compounds in the body but can become harmful when blood levels exceed 135 mg/dl. exceed the body's ability to use it. can only be controlled through medications. a and b.

Answers

Answer:

The correct answer is a and b( exceed 135 mg/dl and can only be controlled through medications.)

Explanation:

Cholesterol is a natural fatty substance that is present in the body and is necessary for the proper functioning of the cells of the human body. It is considered to be at the high limit when the whole blood level exceeds 130 milligrams per deciliter of blood (mg / dl). When this happens, fats tend to build up inside the arteries, impeding blood flow and can lead to serious heart disease and stroke. A doctor usually prescribes drugs to lower high cholesterol (they usually recommend statins), it is because the person is in the intermediate risk limit and has factors that increase the risk of heart disease or stroke, causing long-term arteries become clogged and diseases such as atherosclerosis or heart attack appear.

difference between action potential of sa node and contractile myocytes​

Answers

Different groups of cells depolarize at different rates. The rate of depolarization of SA node cells is faster than the rate of depolarization of AV node cells. ... If both the SA node and AV node fail, the Purkinje fibers have a modest level of automaticity (20 beats/minute) that may still reach threshold

What drug is popular at parties in the West?

Answers

Candy apples because everybody loves them

la vaca Lola la vaca lola

2. Describe social diversity and discuss two examples.

Answers

In we all the society members gather in any problems and solve that problem is call social diversity

Explanation:

if the water tap broken all the society members join and solve to fix that problem.

Social diversity may be defined as the sum total of all humans that live in a single culture and are set apart from each other through various elements of it.

What are the elements of social diversity?

The elements of social diversity are lifestyle, religion, language, ethnicity, race, gender, tastes, preferences, etc.

The examples of social diversity are as follows:

Religious diversity: It is one of the most common and highlighted diversity that is frequently seen across the world. According to the reports, there are approximately 4200 religions are present in the world. But all maintain a relationship of brotherhood and spread peace, harmony, and happiness to the entire world.

Cultural diversity: This type of diversity is considered the subpart of religious diversity. It is associated with the ethnicity of each person and fixed the social norms for the society that aid in raising the values of each family.

Therefore, it is well described above.

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Prescription: XYZ medication 200 mg, 5 tabs bid x 6 days. How many tablets will be dispensed from the pharmacy?

Answers

Answer:

60 tablets

Explanation:

BID means 2x a day, and it says take 5 tablets 2x a day. So, if 10 tablets are taken in one day for 6 days, then 60 tablets will need to be dispensed by the pharmacy.

Judy, a 28 y/o, presents to the clinic with a fever, vaginal discharge, and pain in the lower abdomen, pelvis, and lower back. These symptoms are accompanied by chills, nausea, and vomiting. This presentation is most typical of:

Answers

Pelvic inflammatory disease is what I would say

This presentation is most typical of pelvic inflammatory disease. Pelvic

inflammatory disease affects the reproductive organs in females such as:

UterusFallopian tubeOvary

The symptoms include:

Chills NauseaVomitingVaginal discharge etc

It is usually caused by bacteria which causes various degree of inflammation

and can be treated with the use of antibiotics.

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The UB-04 form has space for more diagnosis codes, but it is not possible to link the procedures to a specific diagnosis. True False

Answers

Answer:

True

Explanation:

The UB-04 stands for the uniform billing form.  It is the standard claim form, printed with red ink on white standard paper, used by institutional providers for the billing of medical and mental health claims. The form can accommodate about twelve diagnosis codes, with four codes mapping to a specific CPT code.  The CPT code describes the treatment and diagnostic services that the healthcare institution has provided for a particular diagnosis, ICD-9.

When the person is being fed through an intravenous central catheter, they are given _____________________ nutrition.

Answers

Total parenteral nutrition
- If they are ONLY being fed this way it would be referred to as Total parental nutrition. = TPN, is used when this is the only source of nutrition the patient is receiving. They're entirely dependent on TPN for all of their nutrition. It is primarily used to treat patients with digestive system disorders or patients who are recovering from a serious accident or surgery.

Parenteral nutrition is used to treat patients who cannot eat or have limited digestive powers by providing a liquid mixture of nutrients directly to the bloodstream. Parenteral nutrition is delivered intravenously to a vein and includes protein, carbohydrates, fats, vitamins, minerals, and any other nutrients required by the body.

Parenteral nutrition is different than enteral nutrition, which is the use of a feeding tube to provide nutrients directly to the stomach for digestion. Parenteral nutrition may be used if a feeding tube didn't work or if the patient suffers from conditions like Crohn's disease, cancer, short bowel syndrome, or ischemic bowel disease to list a few.

A 40-year-old male vegetarian is diagnosed with folate deficiency anemia. He reports that he is an alcoholic. Which of the following factors put him at greatest risk for developing his disease? a. Being vegetarian b. Being alcoholic c. Age d. Gender

Answers

hid gender

because he was diagnosed for folate deficiency anemia

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