Question 13006 of 324 · Texas Life, Accident and Health Agent Exam
Regarding out-of-network claims, an HMO enrollee who is treated by an out-of-network provider in an emergency
Exactly one answer is correct.
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Correct answer to question 13006
- D: is protected from balance billing under the law for certain services
Explanation
For emergency care by a non-network provider and for certain non-network facility-based providers, the enrollee is protected from balance billing. The HMO pays the provider and the enrollee owes only the plan cost-sharing.
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