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AHIP AHM-520 Exam - Topic 6 Question 93 Discussion

Actual exam question for AHIP's AHM-520 exam
Question #: 93
Topic #: 6
[All AHM-520 Questions]

The following statements are about a health plan's pricing of a preferred provider organization (PPO) plan. Three of the statements are true, and one statement is false. Select the answer choice containing the FALSE statement.

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Suggested Answer: C

by Cathrine at Jul 18, 2024, 07:15 PM

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Nada
4 months ago
D is spot on, they always adjust for those factors.
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Carissa
4 months ago
Wait, how can they not estimate provider choices? That sounds weird.
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Lawana
4 months ago
C seems off, I thought they had methods for that.
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Sarah
4 months ago
I think B is definitely true, makes sense.
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Rosendo
5 months ago
Statement A sounds right to me.
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Sage
5 months ago
Statement D sounds familiar, but I’m not completely confident about the weighting process for in-network and out-of-network costs.
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Lorrine
5 months ago
I practiced a similar question where the focus was on adjusting claims costs, and I think statement B is definitely true based on that.
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Filiberto
5 months ago
I'm a bit unsure about statement C; it seems like actuaries should have some way to estimate provider selection, but I can't recall the details.
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Vincenza
5 months ago
I remember that the first step in pricing a PPO involves developing the base indemnity claims cost, so I think statement A is true.
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Evelynn
5 months ago
I'm a bit confused about the last statement - weighting the in-network and out-of-network costs to get a composite claims cost. I'll need to review that part more carefully.
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Santos
5 months ago
Okay, let me think through this. The first step is to develop a base indemnity claims cost, and then the actuaries adjust that for the PPO plan's specific network and provider discounts. The tricky part is estimating employee selection of providers.
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Tamekia
5 months ago
This question seems straightforward, but I want to make sure I understand the key steps in pricing a PPO plan before selecting the false statement.
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Scarlet
6 months ago
The key here is to focus on identifying the false statement. I think I have a good handle on the overall process, so I'll carefully review each option and select the one that doesn't fit.
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Bettina
6 months ago
The key here is figuring out the term that describes the mechanism for a user to consume software rights. I'm leaning towards License as the best answer.
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Truman
6 months ago
Hmm, this is a tricky one. I'll need to think carefully about the specific features required for a Cisco HyperFlex stretched cluster.
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Blair
10 months ago
Ah, the joys of actuarial pricing. It's like a game of 'Guess the False Statement' - except the stakes are higher than a game night bet. Good thing these actuaries have a sense of humor, or they'd be as dry as the desert.
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Phil
9 months ago
C) One difficulty in pricing a PPO is that the health plan's actuaries have no method of estimating which employees would be likely to select which provider groups.
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Sylvie
9 months ago
B) To develop the expected claims costs for the in-network PPO plan, the health plan's actuaries adjust the base indemnity claims costs to reflect pertinent characteristics of the plan, including the specific network plan design and provider discount arrangements.
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Brynn
10 months ago
A) Typically, the first step in pricing a PPO is to develop a base indemnity claims cost, which results from adjusting the indemnity plan as though the entire eligible group of employees is enrolled in the indemnity plan.
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Tran
11 months ago
Yep, A is the false one. I mean, who would be crazy enough to price a PPO plan based on an indemnity plan? That's like trying to build a skyscraper using toothpicks.
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Anthony
10 months ago
Definitely, weighting the in-network and out-of-network costs is crucial for pricing a PPO plan accurately.
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Leila
10 months ago
It's important to adjust the base indemnity claims costs to reflect the specific characteristics of the PPO plan.
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Shonda
10 months ago
I agree, pricing a PPO plan based on an indemnity plan doesn't make sense.
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Bethanie
11 months ago
Haha, A is definitely the odd one out. Developing an indemnity plan as the base? What is this, the 1980s? Get with the times, people!
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Mica
9 months ago
D) After the health plan's actuaries use risk adjustment factors to adjust the existing claims costs for selection issues, the actuaries weight the in network and out-of-network costs to arrive at a composite claims cost for the PPO plan.
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Anissa
9 months ago
D) After the health plan's actuaries use risk adjustment factors to adjust the existing claims costs for selection issues, the actuaries weight the in network and out-of-network costs to arrive at a composite claims cost for the PPO plan.
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Felicitas
9 months ago
C) One difficulty in pricing a PPO is that the health plan's actuaries have no method of estimating which employees would be likely to select which provider groups.
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Joesph
9 months ago
C) One difficulty in pricing a PPO is that the health plan's actuaries have no method of estimating which employees would be likely to select which provider groups.
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Twila
10 months ago
B) To develop the expected claims costs for the in-network PPO plan, the health plan's actuaries adjust the base indemnity claims costs to reflect pertinent characteristics of the plan, including the specific network plan design and provider discount arrangements.
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Keshia
10 months ago
A) Typically, the first step in pricing a PPO is to develop a base indemnity claims cost, which results from adjusting the indemnity plan as though the entire eligible group of employees is enrolled in the indemnity plan.
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Kimberely
10 months ago
B) To develop the expected claims costs for the in-network PPO plan, the health plan's actuaries adjust the base indemnity claims costs to reflect pertinent characteristics of the plan, including the specific network plan design and provider discount arrangements.
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Veronique
11 months ago
A) Typically, the first step in pricing a PPO is to develop a base indemnity claims cost, which results from adjusting the indemnity plan as though the entire eligible group of employees is enrolled in the indemnity plan.
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Theron
11 months ago
I agree, A is the false statement. Everyone knows the base is the PPO plan, not some hypothetical indemnity plan. These actuaries must be living in the past.
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Niesha
10 months ago
I disagree, C makes sense. I believe D is the false statement. Actuaries don't weight in-network and out-of-network costs for a composite claims cost.
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Jordan
11 months ago
I think C is the false statement. Actuaries must have some way of estimating employee preferences.
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Xochitl
11 months ago
I disagree. I believe the false statement is D because actuaries do not weight in-network and out-of-network costs to arrive at a composite claims cost.
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Reed
11 months ago
The false statement is A. Typically, the first step in pricing a PPO is to develop a base indemnity claims cost. That's just plain wrong, the base should be the PPO plan design, not an indemnity plan.
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Weldon
10 months ago
That's correct. They adjust for network plan design and provider discount arrangements.
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Delila
10 months ago
So, the actuaries adjust the base indemnity claims costs to reflect characteristics of the PPO plan, right?
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Glynda
10 months ago
Yeah, I agree. The base indemnity claims cost is not the first step in pricing a PPO.
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Alpha
11 months ago
I think the false statement is A, the base should be the PPO plan design, not an indemnity plan.
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Annabelle
11 months ago
I agree with Gail. Actuaries can estimate which employees would select which provider groups.
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Gail
12 months ago
I think the false statement is C.
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