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

When can a CSNP member change carrier

Answers

Answer: the last month of enrollment in your current plan.

Explanation:If you do not choose another private health or drug plan immediately, your SEP is extended for 90 days from the time of your disenrollment in the plan.

Canadian individual or group medical insurance plans typically cover which of the following?

Answers

Canadian Medicare provides coverage for approximately 70 percent of Canadians' healthcare needs, and the remaining 30 percent is paid for through the private sector. The 30 percent typically relates to services not covered or only partially covered by Medicare, such as prescription drugs, eye care, and dentistry.

Answer:

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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

Martha Wembly has a history of diabetes mellitus, type 2. How is this different from diabetes mellitus, type 1

Answers

Answer and explanation:

Diabetes Mellitus is a condition characterized by high blood sugar levels (hyperglycemia), if not properly controlled this disease can severely damage many organs and cause death.

There are different types of Diabetes Mellitus, Type 1, Type 2, and Gestational (this type of diabetes, in particular, is unique to pregnant women).

In a healthy body, when blood sugar levels are high (for example, right after we eat), Insulin would be released from the pancreatic beta-cells to induce the entering of glucose (also called sugar) into different tissues such as skeletal muscle and fat, where it will be used to produce energy and store the excess for when the body needs it.

Patients that suffer from Diabetes Mellitus cannot get the glucose they ingest into the mentioned tissues, and for that reason, the blood sugar levels stay high and can produce several life-threatening consequences. This incapacity can have different roots and is the reason behind the classification of this condition.

Type 1 Diabetes is the most uncommon of the two and it appears for the first time during childhood or teenage years. Patients with type 1 Diabetes CANNOT produce Insulin, because their pancreatic beta-cells are deficient. For this reason, these individuals have to be administered exogenous Insulin for the rest of their lives.

Type 2 Diabetes is, by far, the most common type of Diabetes. Unlike type 1 diabetics, these patients can produce glucose, but the combination between genetic predisposal and unhealthy habits such as poor diets or sedentarism can lead to a condition called Insulin resistance, in which the tissues cannot accept the glucose even if there's Insulin around. This type of Diabetes usually starts manifesting during adulthood (especially in patients that are older than 40 years old) and is treated with specific medication and a change in their habits.

I can't find the descriptions online. Whats epidermal acanthosis, papillary dermal fibrosis, and parakeratosis? It did say parakeratosis is from lack of zinc but it didn't describe what it WAS.

Answers

Answer:

Acanthosis (thick skin) in chronic eczema. Parakeratosis and a (usually superficial) perivascular lymphohistiocytic infiltrate. Excoriation and signs of rubbing (irregular acanthosis and perpendicular orientation of collagen in dermal papillae) in chronic cases (lichen simplex).

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Overcoming challenges to cultural competence in research requires that: (Check ALL that apply)

Answers

Answer: • Investigators examine and understand of historical contexts for study populations before initiating research study design.

• Early-phase study design should take into account race, ethnicity and cultural factors.

• IRB membership should include representatives of large communities and cultural groups as representatives.

Explanation:

Cultural competence in research refers to the ability of researchers to provide high quality research whereby the culture and the diversity of the population is taken into account during the development of the research ideas and when conducting the research.

The requirements for cultural competence include:

• Investigators examine and understand of historical contexts for study populations before initiating research study design.

• Early-phase study design should take into account race, ethnicity and cultural factors.

• IRB membership should include representatives of large communities and cultural groups as representatives.

I Describe the duties and responsibilities of own work role?​

Answers

Answer:

Your duties and responsibilities refer to your legal and professional obligations as well as the tasks and behaviours that your employer expects from you as part of your job role. Your main duties and responsibilities will be dependent on your own particular role.

Responses of the Mast cells to the allergen include/s a. All of the answers are correct b. Degranulation c. Secretion of lipid mediators d. Secretion of cytokines

Answers

Answer:

The correct answer is - A. All of the answers are correct.

Explanation:

Mast cells are the cells that are present on connective tissue. These cells have many garnules that are filled with histamin and heparin that play role in first line immune response against allergens. Degranuation is the process of releasing these granules.

Other than this mast cells or mastocytes also secrete lipid mediators and cytokines. These are activated and secreted in presence of allergen or anaphalyxis response.

The diversity of both students and faculty poses important considerations for teaching and learning. Reflect on the characteristic differences in gender, race, and culture, as well as the differences among the diverse generations in today’s nursing education classroom. When considering your personal philosophy of teaching, discuss how you might use these characteristic differences and diverse backgrounds and experiences of today’s nursing students as a teaching tool to connect students to nursing content and increase their understanding. In other words, how might you incorporate the background and experiences of your students into your teaching methods to enhance the ability of all students in your classroom to think critically and problem solve patient-care issues?

Answers

Answer:

As of 2016, the ethnic breakdown of the United States was 61.3 percent white (non-Hispanic/Latino), 17.8 percent Hispanic/Latinx, 13.3 percent black/African-American, 5.7 percent Asian, 1.3 percent Native American/Alaskan Native, and 2.6 percent reporting two or more races. In the same year, about 70 percent of all nurses were white — significantly more than the general population. African-American and Latinx populations in particular were underrepresented as a proportion of the nursing profession. The contrast was even more stark when considering nursing educators. In 19 states, the percentage of minority nursing students was at least double that of minority faculty.

This disparity can be a barrier to effective nursing education. Studies by respected organizations, such as the Sullivan Commission on Diversity in the Healthcare Workforce, show that educational outcomes improve when nurse educators reflect, value, and celebrate the diverse attributes of the student groups they teach. On the other hand, educational outcomes suffer when nurse educators fail to do these things. Diversity within an organization’s teaching staff is therefore a helpful tool for attracting, retaining, and training enthusiastic and skilled nursing students.

Occurs when an area heart muscle dies or is permanently damaged because if an inadequate supply of oxygen to that area; also known as heart attack.

Answers

Myocardial Infarction (Heart Attack)

It occurs when an area heart muscle dies or is permanently damaged because if an inadequate supply of oxygen to that area. It is a life threatening emergency.

Symptoms of myocardial infarction are anxiety, shortness of breath, tightness in chest, dizziness and etc.

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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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How many grams of zinc oxide should be added to 3400 g of a 10%
zinc oxide ointment to prepare a product containing 15% of zinc oxide?

Answers

The amount in grams of zinc oxide should be added to 3400 g of a 10% zinc oxide ointment to prepare a product containing 15% of zinc oxide - 200 grams.

In the given question,

the initial amount of zinc oxide is - 10% of 3400 = 340 gramsthe amount needs to be added - x gramsthe final product have - 15% of 3400+x

solution:

[tex] \frac{340 + x}{3400 + x} = 0.15 \\ 340 + x = 510 + 0.15x[/tex]

[tex]x = \frac{510 - 340}{1 - 0.15} = 200[/tex]

x = 200 gram.

Thus, the correct amount would be - 200 grams.

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What drug is popular at parties in the West?

Answers

Candy apples because everybody loves them

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What is a thyroid storm, and why would the admitting doctor want to consider this as a possible diagnosis

Answers

Answer:

Explanation:

Thyroid storm can be described as a condition that arises as a result of prolonged untreated hyperthyroidism. This condition is more described with the overproduction of two thyroid hormones.

Also, people with thyroid storm have low level of TSH hormone and high level of T3 and T4 hormone.

Thyroid storm is also classified with high blood pressure,high respiratory rate, high body temperature. These symptoms and some hormone level test of TSH, T3 and T4 would make the doctor consider admission.

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.

Hank is a competitive endurance athlete who weighs 80 kg and trains for less than 4 hours a day. He would like to plan a nutritionally adequate diet that provides enough carbohydrate to maintain his weight and glycogen stores during training and competition. According to expert recommendations, he should consume _____ grams of carbohydrate daily.

Answers

Answer: 480 to 800

Explanation:

Based on the information given, according to expert recommendations, he should consume 480 to 800 grams of carbohydrate daily.

This is calculated as:

(80kg × 6) - (80kg × 10) = 480 - 800 grams.

Assuming his weight is 90kg, the grams of carbohydrate to be consumed will be. 540 to 900 grams.

A food worker has been slicing melons for four hours in her single use glove should she change them

Answers

Answer:

Yes

Explanation:

Its just simple hygiene

Answer:

yes because it is nasty if you dont wash you hands after that long because your getting the gloves all dirty and sweaty

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

Bone cells are called:

Answers

Answer:

Bone is a mineralized connective tissue that exhibits four types of cells: osteoblasts, bone lining cells, osteocytes, and osteoclasts.

Nursing students in a community health nursing course identified toxic waste disposal to be a major problem in their community. The instructor recognizes the students understand the appropriate approach to handle the situation by conducting which type of assessment

Answers

Answer: problem oriented

Explanation:

The options include:

a. comprehensive

b. problem oriented

c. familiarization

d. community subsystem

Based on the information given, the assessment conducted is a problem oriented assessment. This is an assessment whereby a particular problem is thoroughly assessed and the areas that aren't related to the problem isn't covered.

In this case, the instructor recognizes the students understand the appropriate approach to handle the situation by conducting the problem oriented assessment.

Answer: trouble orientated

Explanation:

The alternatives include:

a. complete b. trouble orientated

c. familiarization

d. network subsystem

Based at the data given, the evaluation carried out is a trouble-orientated evaluation. This is an evaluation wherein a specific trouble is very well assessed and the regions that are not associated with the trouble is not covered.

In this case, the trainer acknowledges the scholars recognize the correct technique to address the state of affairs via way of means of carrying out the trouble-orientated evaluation.

What is health?

Health is the state of being active and fit. Your body and other organs also work properly.

Thus it is clear that it is explained above.

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Why have risky behaviors for zoonotic diseases continued even though we know that some of these diseases can infect humans?

Answers

Answer: Zoonotic diseases are those diseases that are transferred from animals to humans.

Explanation:

In zoonotic diseases animals are the vectors for the transfer of disease from humans to animals. The organisms that are transferred through zoonotic diseases are bacteria, viruses, fungi, and parasites. Mostly the disease causing organisms are parasites. For example rabies, Lyme disease, plague, salmonellosis, west nile virus, and others. These diseases develop risky human behavior. For example humans affected by rabies show phobia from water. Some humans also develop biting tendency.

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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To be successful in coding for anesthesia what will you need? A. The Relative value guide published by the American Society of Anesthesiologists, B The Physicians desk reference, C. Strong knowledge of anatomy, D. Both a and c.

Answers

its both aaaaaaa and ccccccc

a goiter can result fromtoo much or too little iodine in the diet. choline supplementation. vitamin A toxicity. chromium deficiency.

Answers

Answer:

Too little iodine in diet

Explanation:

Goitre could occur as a result of too little iodine in diet. When there is not enough iodine in the diet, it canresult to goitre. This is why iodine is added to table salt in most countries of the world to combat iodine deficiency.

54.Uterine subinvolution after normal delivery may occur as a
result of:
a. Vaginal infection
b. Urinary tract infection
c. Gastroenteritis
d. Endometritis

Answers

It is the Endometriosis

What is the molar that inclined distally ?

Answers

Answer:

The mesially inclined crown of the retained tooth is hooked under the round distal contour of the second molar, with the crown contacting the root of the second molar.

EThe

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.

Meredith in labor for the first time she had a normal pregnancy and good prenatal care labor preceded normal until she was dilated to 4 cm since that point no progress has taken place it has been 12 hours meredith is tired and frustrated the fetus demonstrates no stress as of yet meredith is scheduled for a c-section

Answers

Answer:

Explanation:

A C-section scheduled for Meredith is best for her. A dilation of 4cm can't proceed with normal labor. Being in labor for 12 hours is dangerous for the mother and fetus. Even if the fetus demonstrates no stress yet, it is safer to have a C-section for Meridith to keep the mother and fetus in good status.

using the cpt code book, assign code(s) for the following scenario: Dr. Smith admits Ralph to a nursing home. He performs a comprehensive history, comprehensive examination and medical decision making of high complexity. Code for the initial visit for admission of a patient to a nursing home. List the CPT code verified in the Tabular List.

Answers

Answer:

CPT Code 99306

Explanation:

Since Dr. Smith performed a comprehensive history and examination on Ralph with a high medical decision making complexity, the verified CPT code would be 99310.

What is CPT code?

CPT code is an abbreviation for current procedural terminology code and it can be defined as the set of numbers that are formally assigned to each task and service that is being offered by a healthcare provider.

Basically, a current procedural terminology (CPT) code is typically used by an insurer to determine the amount of money that should be paid to a healthcare provider for the services rendered.

Since Dr. Smith performed a comprehensive history and examination on Ralph, and the medical decision making is of high complexity, the verified CPT code would be 99310.

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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.

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