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AHIP Exam AHM-530 Topic 1 Question 65 Discussion

Actual exam question for AHIP's AHM-530 exam
Question #: 65
Topic #: 1
[All AHM-530 Questions]

When the Rialto Health Plan determines which of the emergency services received by its plan members should be covered by the health plan, it is guided by a standard which describes emergencies as medical conditions manifesting themselves by acute symptoms of sufficient severity (including severe pain) such that a person who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual in serious jeopardy. This standard, which was adopted by the NAIC in 1996, is referred to as the

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Suggested Answer: A

by Leatha at Feb 02, 2023, 04:52 PM

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Lezlie
12 days ago
Reasonable and customary, huh? I guess that's what they call it when your insurance tries to lowball you on the bill. Better stick with the prudent layperson standard for this one.
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Corrinne
23 days ago
The 'all-or-none' standard? Really? Who even comes up with these weird options? I bet the exam writer had a chuckle putting that one in there.
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Ashleigh
9 days ago
I know, right? These options can be so random sometimes.
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Albina
27 days ago
I was tempted to go with the medical necessity standard, but the passage clearly states that the prudent layperson standard was adopted by the NAIC in 1996. Gotta go with the right answer, even if it's not what I initially thought.
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Eura
3 days ago
I agree, the passage clearly states that the prudent layperson standard was adopted by the NAIC in 1996.
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Wilford
1 months ago
The prudent layperson standard seems to be the correct answer here. It focuses on the severity of the symptoms and the reasonable expectation that without immediate care, the person's health could be in serious jeopardy. This makes sense for emergency services coverage.
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Danica
1 months ago
I'm not sure, but I think it's between A) medical necessity standard and B) prudent layperson standard.
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Bong
1 months ago
I agree with Han, the prudent layperson standard makes sense for determining emergency services coverage.
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Han
1 months ago
I think the answer is B) prudent layperson standard.
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