New York Child Abuse Identification and Reporting Practice Exam

Which of the following is TRUE of a point of service plan?

1. A patient's care is coordinated by an in-network primary care physician.

2. Patients can only visit in-network providers.

3. Out-of-network services are not covered at all.

4. Emergency care is always covered at an in-network rate.

The correct answer is: A patient's care is coordinated by an in-network primary care physician.

A point of service (POS) plan is a type of managed care health insurance that combines features of both health maintenance organizations (HMOs) and preferred provider organizations (PPOs). In this context, one key aspect of a POS plan is that a patient's care is typically coordinated by an in-network primary care physician (PCP). This PCP is responsible for managing the patient's healthcare needs, including referrals to specialists, ensuring that care aligns with the plan's network, and facilitating necessary services. Choosing an in-network primary care physician is essential within a POS plan, as it determines the level of coverage and cost-sharing for the services rendered. By coordinating care through a designated in-network PCP, patients can benefit from lower out-of-pocket expenses and a streamlined approach to managing their health care. Other aspects of a POS plan include allowing for some out-of-network services, albeit at a higher cost to the patient, and potential variations in coverage for emergency care. However, these nuances do not diminish the importance of having an in-network primary care physician guiding the patient's healthcare journey. This understanding highlights the role of the in-network PCP in ensuring coordinated and effective care within a POS plan, making the provided answer accurate.