Smmc Refresher Quiz #16

7 Questions | By AHSFLTrainer | Last updated: Mar 16, 2022 | Total Attempts: 211

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Good Cause

Questions and Answers

1.

An enrollee has to receive a response to the grievance before HealthTrack will allow the Good Cause plan change to be processed.
- A.
  
  True
- B.
  
  False
2.

The enrollee is locked in and says: "My plan has changed my primary care provider five times in the past few months. I just want to get comfortable with one provider and when I ask them why I am being changed, they won't give me an answer! Can I change my plan? Which Good Cause Reason can you use?
- A.
  
  GC4
- B.
  
  The enrollee does not qualify for a Good Cause plan change at this time.
- C.
  
  GC9
- D.
  
  GC1620
3.

The enrollee is locked in and says: "My Cardiologist told me I need to see an Electrophysiologist, but my plan does not cover that kind of specialist. Can I change my plan?" Which GC would apply?
- A.
  
  GC9
- B.
  
  GC1623
- C.
  
  GC7
- D.
  
  The enrollee does not qualify for a Good Cause plan change at this time.
4.

All Good Cause plan changes will be approved regardless of the reason.
- A.
  
  True
- B.
  
  False
5.

The enrollee is locked in and says: "Whenever I try to go to an appointment with my doctor it takes forever to be seen! This is the only provider in the area that accepts my plan. Can I change my plan?" Which Good Cause Reason can you use?
- A.
  
  GC4
- B.
  
  GC9
- C.
  
  The enrollee does not qualify for a Good Cause plan change at this time.
- D.
  
  GC1621
6.

What happens after an enrollee is approved for a Good Cause plan change?
- A.
  
  An additional 60 day change period will be granted.
- B.
  
  An additional 120 day change period will be granted.
- C.
  
  The enrollee will be locked in to the new plan.
- D.
  
  An additional 90 day change period will be granted.
7.

An enrollee is really upset and states they have received a denial letter from an attempted GC9 plan change. Their provider stopped accepting the plan and the enrollee does not want to change providers because this provider has all of their medical information and they are comfortable with them. How should you proceed?
- A.
  
  Advise the enrollee of their lock-in and open enrollment dates and tell them to call back to change when they are in their open enrollment period. Offer to file a complaint and include detailed notes.
- B.
  
  Submit the plan change request in the discrepancy log since the enrollee has a good reason to change the plan.
- C.
  
  Process another GC9 plan change and add that the enrollee is terminally ill so the request will not be denied.
- D.
  
  Refer the caller to AHCA to find out why the GC9 was denied since it's not the caller's fault the PCP is not taking the plan anymore.