Managed Care (2) - Managed Care 1 The Pros and Cons of...

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Managed Care 1 The Pros and Cons of Managed Care University of Phoenix Axia College
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Managed Care 2 With every plan, there are limitations and steps that the patient and caregivers must consider in order to find the plan that best suits their needs. Traditional health insurance coverage involves the person choosing any doctor or hospital at the time service is needed. A referral is not needed. With traditional health insurance, providers bill the person or their insurance company for each service performed. The individual usually pays a deductible and percentage of the provider’s fees and is usually reimbursed for 80 percent of the usual charges for covered services. He or she is liable for additional billing if the health plan does not pay the full charges. There are three general types of managed care systems; Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Point of Service (POS). HMOs contract with a network of hospitals, doctors and services to provide treatment. The person goes to a Primary Care Physician (PCP) who controls the services the patient has and does the referrals. The patient must use only the facilities and doctors in the network. In a PPO, the company
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This note was uploaded on 09/28/2011 for the course HCA 230 230 taught by Professor Jones during the Spring '11 term at University of Phoenix.

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Managed Care (2) - Managed Care 1 The Pros and Cons of...

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