Deal of The Day! Hurry Up, Grab the Special Discount - Save 25% - Ends In 00:00:00 Coupon code: SAVE25
Welcome to Pass4Success

- Free Preparation Discussions
Mail Us support@pass4success.com
Location US
Mob_nav_barsMENU

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.

Show Suggested Answer Hide Answer
Suggested Answer: B

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

Limited Time Offer

25%

Off

Get Premium AHM-520 Questions as Interactive Web-Based Practice Test or PDF

Contribute your Thoughts:

0/2000 characters
Submit Cancel
Lindsey
10 months ago
This seems a bit off, are we sure about the attachment point details?
upvoted 0 times
...
Oliva
10 months ago
I thought stop-loss meant they wouldn't pay until after the expenses were settled?
upvoted 0 times
...
Catalina
10 months ago
Wait, does that mean Longview is on the hook for the first $2M?
upvoted 0 times
...
Roosevelt
10 months ago
I agree, that's how stop-loss works!
upvoted 0 times
...
Jaclyn
10 months ago
Sounds like Carlyle has to cover the costs before Longview pays anything.
upvoted 0 times
...
Hortencia
11 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.
upvoted 0 times
...
Tamera
11 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.
upvoted 0 times
...
Carlene
11 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.
upvoted 0 times
...
Goldie
11 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.
upvoted 0 times
...
Roslyn
11 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.
upvoted 0 times
...

Save Cancel