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AHIP AHM-520 Exam - Topic 5 Question 29 Discussion

The Longview Hospital contracted with the Carlyle Health Plan to provide inpatient services to Carlyle's enrolled members. Carlyle provides Longview with a type of stop-loss coverage that protects, on a claims incurred and paid basis, against losses arising from significantly higher than anticipated utilization rates among Carlyle's covered population. The stop-loss coverage specifies an attachment point of 130% of Longview's projected $2,000,000 costs of treating Carlyle plan members and requires Longview to pay 15% of any costs above the attachment point. In a given plan year, Longview incurred covered costs totaling $3,000,000.Carlyle most likely is responsible for paying Longview for the claims incurred before Longview has actually paid the medical expenses.
B) False
A) True

AHIP AHM-520 Exam - Topic 5 Question 29 Discussion

Actual exam question for AHIP's AHM-520 exam
Question #: 29
Topic #: 5
[All AHM-520 Questions]

The Longview Hospital contracted with the Carlyle Health Plan to provide inpatient services to Carlyle's enrolled members. Carlyle provides Longview with a type of stop-loss coverage that protects, on a claims incurred and paid basis, against losses arising from significantly higher than anticipated utilization rates among Carlyle's covered population. The stop-loss coverage specifies an attachment point of 130% of Longview's projected $2,000,000 costs of treating Carlyle plan members and requires Longview to pay 15% of any costs above the attachment point. In a given plan year, Longview incurred covered costs totaling $3,000,000.

Carlyle most likely is responsible for paying Longview for the claims incurred before Longview has actually paid the medical expenses.

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Suggested Answer: B

by Kimberlie at May 05, 2022, 11:18 PM

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Lindsey
9 months ago
This seems a bit off, are we sure about the attachment point details?
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Oliva
9 months ago
I thought stop-loss meant they wouldn't pay until after the expenses were settled?
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Catalina
10 months ago
Wait, does that mean Longview is on the hook for the first $2M?
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Roosevelt
10 months ago
I agree, that's how stop-loss works!
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Jaclyn
10 months ago
Sounds like Carlyle has to cover the costs before Longview pays anything.
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Hortencia
10 months ago
Hmm, I'm a bit unsure about this one. I think it might be B, the current value and how much it will grow over time, but I'm not totally sure. I'll have to think it through carefully.
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Tamera
10 months ago
I'm pretty sure the answer is A. Operating expenses are the usual and customary costs a company incurs to support its main business.
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Carlene
10 months ago
I'm a bit confused by this question. The wording is a little tricky, and I'm not sure I fully understand the differences between all these document types. I'll have to review my notes and try to reason through this one.
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Goldie
10 months ago
Creating compelling ads and promoting successful organic posts sounds like a solid strategy to me. That way I can leverage both paid and unpaid channels to reach my target audience.
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Roslyn
10 months ago
Ugh, I'm really struggling with this. The distinctions between private and public police powers are so nuanced. I'm going to have to guess on this one.
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