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16. A member, covered under an HMO plan, had a 7 day non-emergent inpatient stay at a hospital not in the health plans network. The
16. A member, covered under an HMO plan, had a 7 day non-emergent inpatient stay at a hospital not in the health plans network. The total charges for the stay were $42,000. The inpatient rate at in-network hospitals is a per diem of $1,000. What payment is the hospital entitled to?
A. $10,000
B. $7,000
C. $42,000
D. $25,000
18.True or False: Non-profit health plans must set the premium to equal the total medical cost to ensure the organization earns no profit:
A. True
B. False
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