Types of Managed Health Care
Health insurance can be divided into two categories: reimbursement and managed health care. The purpose of this article is to provide more information about the different types of managed health care, their advantages and disadvantages.
Managed health care is a program where a group of people pool together their resources to insure themselves against possible high medical costs. This type has much wider coverage than the reimbursement system, but has its limitations as well. The insurance companies have their special arrangements with certain specialist and health care providers. You as a member of this program get a discount for services rendered within this network. If you decide to go out of it you will have to bear some of the costs of the treatment.
There are three types of managed health care: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point-of-Service Plans (POS).
HMOs
In this case you need to choose your own primary physician. Every time you have a complaint you have to go through this person that will evaluate your condition and refer you to another specialist if needed. He will also coordinate your treatment with all the other related specialists. In case of emergencies you can freely go to any doctor for immediate help. Otherwise, if you go for treatment outside of the network you might need to cover a great part of the expense from your own pocket.
PPOs
This method is a bit more flexible that HMOs. It also has a list of hospitals and doctors that it has special relations with. However, you still have the choice to go to outside specialist and use their services. The health plan will cover some and sometimes all of the costs incurred. In most cases you will have to pay the difference between the discounted rates with the in network provider and the outside provider yourself. You might also need to pay immediately for the treatment and then claim reimbursement from the insurance company.
POS
You again have a designated physician. You will have to pay additionally only if the specialist you go to is not referred to you from your primary physician. This way you can have a much greater choice if you agree with your doctor that you need treatment from a particular specialist.
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