HCR 220 Checkpoint 1

HCR 220 Checkpoint 1 - is required for some procedures With...

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With indemnity plans you can chose any provider that you wish to have with little or no cost containment but preauthorization is required for some procedures. With the indemnity plans preventive care is not usually covered and there are higher costs, deductibles, and co- insurance. Health Maintenance Organization (HMO) you can only use providers within your HMO network. The primary care physician manages the care and a referral is required. There is no payment for out-of-network nonemergency services and a preauthorization is required. There is a low copayment, but limited providers in network and it does cover preventive care. With Point-of-Service (POS) and Preferred Provider Organization (PPO) you can use network providers or out-of-network providers. With POS the primary care physician manages the care and with PPO a referral is not required for specialist, fees are discounted, and preauthorization
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Unformatted text preview: is required for some procedures. With both POS and PPO there is a lower copayment for network providers and higher co-pay for out-of-network providers. Consumer-Driven Health Plan is similar to the PPO. Consumer-Driven Health Plans have a high deductible but a low premium. There is also a savings account that is used to pay medical bills before the premium has been met. I believe that the HMO’s provides more benefits to the provider. With HMO’s you may only use their network providers. Patients have to pay a fixed premium for coverage and must only use their doctors and hospitals. PPO’s I believe have more coverage benefits for the consumer. W PPO’s allow patients to use any doctor or hospital they would like to use, but they are charged less if they use one of the doctors or hospitals that have been approved by the PPO plan....
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