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AHIP AHM-520 Exam - Topic 5 Question 30 Discussion

Posted by Fannie on May 03, 2022 at 09:34 PM

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.

For the year in which Longview's incurred covered costs were $3,000,000, the amount for which Longview will be responsible is:

Suggested Answer: C

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8 comments · newest first
LU
Lucina 1 year ago
Are we sure about that? Looks like it could be more.
DE
Dean 1 year ago
Totally agree, it’s definitely $2.66M!
RO
Rosann 1 year ago
Wait, how does the 15% work out? Seems complicated!
RO
Roosevelt 1 year ago
They’ll be responsible for $2.66M after the stop-loss kicks in.
CR
Cristal 1 year ago
Longview's costs were $3M, so they exceed the $2M projection.
LU
Luz 1 year ago
This is a tricky one. I'm thinking Workspace ONE UEM and either the Unified Access Gateway or Hub Services would be needed, but I'm not 100% sure. I'll need to review the details of each component to make sure I'm choosing the right ones.
KA
Kate 1 year ago
I'm pretty confident I know the answer to this. It's got to be a technical measure, like some kind of automated system to check contract dates.
LI
Linwood 1 year ago
The rotate tool doesn't seem like it would be used to locate grids on a ceiling, so I'm going to go with that as the answer.
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