A client has a private insurance policy that pays for most health ...

[erika]

A client has a private insurance policy that pays for most health care costs and services. Why is this plan called a third-party payer?
 
  A) The insurance company pays all or most of the costs.
  B) The family of the client is required to pay costs.
  C) The client gets the bill and pays out-of-pocket costs.
  D) Medicare and Medicaid will pay most of the costs.

Question 2

Medicare uses a prospective payment plan based on diagnosis-related groups (DRGs). What are DRGs?
 
  A) Locally supported health care financing, usually by donations
  B) A public assistance program for low-income individuals
  C) Predetermined payment for services based on medical diagnoses
  D) A private insurance plan for subscribers who pay a copayment

[johnharpe]

Answer to Question 1

Ans: A
Insurance for health care may be financed through private insurance, in which members pay a monthly premium. These plans are called third-party payers, because the insurance company pays all or most of the cost of care.

Answer to Question 2

Ans: C
Medicare, based on DRGs, pays a hospital a fixed amount that is predetermined by the medical diagnosis or specific treatment rather than by the actual cost of hospitalization and care. This plan was put into effect in an effort to control rising health care costs. It is not supported by donations; it is not a public assistance program or a private insurance plan.