If an enrollee uses more services thatn originally assumed per the PPPM calculation, then the plan would
a. show a profit for that period
b. show a loss for that period
c. need a contract renegotiation
d. require that the enrollee be dropped from the plan
I chose c
To determine the correct answer, let's break down the options one by one:
a. Show a profit for that period: This option suggests that if an enrollee uses more services than originally assumed, the plan would still show a profit for that period. However, this would not be the case as providing more services than initially expected would likely result in increased costs for the plan, leading to a potential loss rather than a profit.
b. Show a loss for that period: This option indicates that if an enrollee uses more services than originally assumed, the plan would show a loss for that period. This seems plausible since providing additional services can result in higher expenses than budgeted, potentially resulting in a financial loss for the plan.
c. Need a contract renegotiation: This option implies that if an enrollee uses more services than originally assumed, the plan would require a contract renegotiation. While it is possible that such a situation could prompt further negotiations with service providers or renegotiation of the plan's terms with the enrollee, it may not be the direct consequence of an enrollee utilizing more services.
d. Require that the enrollee be dropped from the plan: This option suggests that if an enrollee uses more services than originally assumed, the plan would require that the enrollee be dropped from the plan. However, typically, plans do not drop enrollees simply for utilizing more services than estimated PPPM (per patient per month). Enrollees are generally entitled to receive the necessary care covered by their plans, even if it results in increased costs for the plan.
Based on the analysis above, the most suitable option would be b. Show a loss for that period, as an enrollee using more services than originally assumed can lead to increased expenses, potentially resulting in a financial loss for the plan.