Features of Health Plans

Features of Health Plans - primary care physician. In PPOs,...

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Features of Health Plans Ashley Hogue HCR/220 July 6, 2011 Pamela Kerby
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Indemnity plans allow you to choose any provider you want, at little or no cost containment. However, preauthorization may be required for certain procedures. Indemnity plans have coinsurance, higher costs, and deductibles. Usually preventive care is not covered. In a Health Maintenance Organization, also known as an HMO, patients can only visit network providers for that HMO. A patient’s primary care physician is the manager of a patient’s care, and to see any other provider, a referral by that primary care physician is necessary. The HMO will not issue payment for any non-emergency services that are provided out-of-network. Preauthorizations are required. Copayments are low and preventive care is covered, but there are limited to in-network providers. Preferred Provider Organizations (PPOs) and Point-of-Service (POS) enable patients to use either network or out-of-network providers. In POS care, the patients care is managed by the
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Unformatted text preview: primary care physician. In PPOs, a visit to a spet does not require a referral. In addition, fees are discounted, but some procedures do require preauthorization. Both PPOs and POS have lower co pays for providers that are in-network and higher co-pays for providers that are out-of-network. A Consumer-Driven Health Plan has similarities to PPOs. They have low premiums but high deductibles. Savings accounts are used for payment of medical bills prior to premiums being met. HMOs, in my opinion, provide greater benefits to providers since patients are limited to in-network providers. Fixed premiums have to be paid by patients for coverage, and these patients can only use the networks hospital and doctors. PPOs appear to be more beneficial for patients. That are able to go to any hospital or see any doctor they wish, but can save money by going to a hospital or seeing a doctor that the PPO plan approves....
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This note was uploaded on 07/09/2011 for the course HCR 220 taught by Professor Cvibanez during the Spring '10 term at University of Phoenix.

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Features of Health Plans - primary care physician. In PPOs,...

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