CPB Certified Professional Biller Certification Practice Exam

What is the purpose of a catastrophic cap benefit?

1. To limit the number of treatments a patient can receive

2. To establish maximum payment limits to protect patients from financial loss

3. To provide insurance coverage for preventive care only

4. To facilitate quicker access to specialty care

The correct answer is: To establish maximum payment limits to protect patients from financial loss

The purpose of a catastrophic cap benefit is to establish maximum payment limits to protect patients from financial loss. This type of benefit is designed to ensure that an individual's out-of-pocket expenses do not exceed a specific threshold. Once this cap is reached, the insurance plan generally covers 100% of the medically necessary services for the remainder of the policy year. This protects patients from overwhelming financial burdens that can result from high medical expenses, particularly in the event of serious or catastrophic health issues that require extensive treatment. This function is critical in healthcare systems, where unexpected health incidents can lead to significant costs that may be difficult for patients to bear. By implementing a catastrophic cap, patients can feel more secure regarding their financial liability, allowing them access to necessary healthcare without the worry of excessive debt. The other options do not accurately reflect the true nature of the catastrophic cap benefit, as none speak to the financial protection aspect that is central to its purpose.