Author Question: Under an HMO setup, members pay a set amount every month and the HMO agrees to provide all their ... (Read 41 times)

itsmyluck · **on:** Jun 27, 2018

Under an HMO setup, members pay a set amount every month and the HMO agrees to provide all their care.

Indicate whether this statement is true or false.

Question 2

What is surgery? Discuss this branch of medicine and its relationship to benefit plans.

What will be an ideal response?

Sophiapenny · **Reply #1 on:** Jun 27, 2018

Answer to Question 1

Answer: F

Answer to Question 2

Answer:
Surgery is the branch of medicine that treats diseases, injuries, and deformities through operative or invasive methods. Although surgery usually involves cutting, cutting does not have to be involved for a procedure to be considered surgical. The surgical concept is anything that involves removing, altering, repairing, entering, or the carrying out of any other invasion of the body. Therefore, insertion of a tube into a person's throat does not involve cutting but is considered surgical in nature because it invades the body. There are also many laser procedures that are considered surgical.
Most benefit plans cover only surgeries that are necessitated by disease or injury. In other words, the procedure must be considered medically necessary to repair or improve function or diagnose an illness. In addition, because a procedure is listed in the surgery section of the CPT does not mean that the procedure is allowable under a benefit plan, nor does it mean that it will necessarily be coded as a surgical procedure. The coding of procedures varies from company to company.