CPB (Certified Professional Biller) Certification Practice Exam

What did the Amendment to the HMO Act of 1973 allow members to do?

1. Be treated only by HMO physicians

2. Seek treatment from non-HMO physicians without reimbursement

3. Use non-HMO physicians occasionally and receive partial reimbursement

4. Receive no outside medical care

The correct answer is: Use non-HMO physicians occasionally and receive partial reimbursement

The amendment to the HMO Act of 1973 expanded the options available to members of Health Maintenance Organizations (HMOs). It allowed members to seek treatment from non-HMO physicians and receive partial reimbursement for those services. This change provided greater flexibility for enrollees, enabling them to access a broader range of healthcare providers while still being part of the HMO system. This flexibility was important because it acknowledged that while HMOs provide comprehensive care through their network of providers, some patients might prefer or need to see specialists or other providers outside of the HMO network. The allowance for partial reimbursement supports the idea of continuity of care for patients who may require services not available within the HMO's network.