Answer to Question #285491 in Economics for Babygirl

Question

Jesse belongs to an HMO that requires precertification and preauthorization for certain medical care. Jesse does not like any of the physicians in the HMO, so he decides to go to a physician out of the network. When he receives his bill for care, his insurance has only made a minimal payment, and he is responsible for a large portion of the bill. What did Jesse do that minimized the payment? Would preauthorization or precertification make a difference in the payment?

Answer 1

Either Jesse have not paid the deductible or he haven't approached his insurance company before getting the service, the insurance will make a minimal payment only, and he is responsible for a large portion of the bill, because preauthorization and precertification makes a difference.