Case Study : Why We Chose A PPO

There are several types of private payer plans including preferred provider organizations (PPO’s), health maintenance organizations (HMO’s), and point of service (POS). Indemnity plans would cost the most for employees and they usually choose a PPO plan. A trend that is gaining popularity with employees and employers is the consumer driven health plan (CDHP) that has a high deductable combined with a funding option of some type. All of the plans have unique features for coverage of services and financial responsibility.

The HMO’s stress wellness and preventive care, therefore its focus is more on health maintenance rather than just the treatment itself. Because of this, HMO’s offer much richer benefits than the traditional plans. HMO’s have little to no upfront costs in an effort to encourage maintenance, while comprehensive and major medical plans have up-front cost sharing so as to discourage over utilization.

EPO vs HMO-- EPO contracts solely with specific specialists, clinics, hospitals and other health care providers to form a network. EPO clients know they don't have many options when it comes to providers, but they do have the comfort of knowing they'll always be reimbursed for any in-network expenses. HMO’s requires a co-payment on each visit while EPO’s have no co-pays. Both EPO’s and HMO’s keep costs low. EPO’s do not require a referral while HMO’s must confirm that specialized care is required before they will issue a referral

When you look over your health insurance choices this year, there will be an option to select high-deductible health plan on the menu. These types of healthcare plans are increasingly becoming popular amongst healthcare seekers and consumers. So, why would anyone choose an insurance policy with greater out-of-pocket costs? Plans with higher deductibles typically have lower premiums, so you'll keep more of your paycheck. A High Deductible Health Plan (HDHP) is a plan that has a higher annual deductible than a typical health insurance plan; maximum limit on the sum of the annual deductible and out-of-pocket medical expenses that an enrollee must pay for covered expenses. The out-of-pocket expenses for a High Deductible Health Plan are

As a single employee, I want to select a PPO health network as my medical insurance so that I can continue to see my current family doctor.

Insurance with HMO patient may pay a copayment of $15.00 compared to a patient who has PPO may pay $25 copayment for the same services.

The PPO gives discounts, with its doctors and hospitals that participation, and then pays a fee for services given. Patients have a list that they can pick from for a primary physician. The patient pays a set fee per office visit and the insurance provider pays the rest. It’s basically a co-payment which depends on what type of plan they have. However, like an HMO, the PPO has to choose a physician in that network, if they don’t they may be charged a penalty.

Prior to having a high deductible plan I had traditional personal choice insurance plan that I was able to get from my employer for my family of five for $240.00 a paycheck which was twenty six bi-weekly costing me $6,240 out of immediate salary with an eighty to twenty deductible. The first year my premium went down to $121.78 a biweekly paycheck. The high deductible was $2000. My employer paid $1000.00 and once deductible was met all costs under insurance were covered. Since then the premium went to $137.74 with a $3000.00 deductible. Currently my premium is $160.96 a bi weekly paycheck with a $4000.00 deductible and now an eighty/twenty deductible at office visits, prescription plans. There are allotted certain automatic fees for hospitalizations and high costs testing. A few preventative care costs are included for example, once a year well visits. If I pay into my HAS account I have started with fees as listed earlier then an ongoing fees of $5.00 a month to maintain it. In order to just cover the $4000.00 deductible I have to take out of my pay $153.85 bi weekly just to meet. In order to use advantage of tax free income the benefits of putting more into HAS do not outweigh other needs and costs. I have put in more than needed to meet deductible to help with copays. On top of what is not included my husband has type I diabetes on an insulin pump which the equipment is only covered 66%. Having using the insulin

When purchasing insurance it is extremely imperative that one assesses all of the benefits, specifications, and details offered in order to choose the best plan in regards to deductibles, co-pays, and coinsurance-just to name a few. Among the “Top Two” plans that I chose, if I was to purchase health insurance today I would choose the United Healthcare Silver Compass H.S.A. 3600 plan, as it fulfills my healthcare needs the most. This specific plan only has a $500 deductible, full premium, and $0 copay after the $500 dollar deductible for all of the services I currently use the most. In addition, the estimated cost of this plan per month is $13.37.

HMO is a cost-effective plan since you must choose a primary care physician and need a referral to see a specialist since they are coordinating the care it will lower the out of pocket expense. As for PPO is one stays in- network they may only be responsible for a co-pay. The way that POS works are that it has some features of both the HMO and the PPO however since options are limited this is how they can keep the cost low. As for a recommendation, it would depend on the needs of the individual and how much control they prefer to have their health insurance in regards to what doctor they prefer to see. I believe the PPO plans offer more flexibility and would be the best option since it does allow the opportunity to save while not limited on

The pros for an HMO are there is less hassle in choosing a specialist in everything because your physician does that. Some cons are your provider has to be in the network and you need precertification 48 hours ahead in order for coverage. Some pros for fee-for-service pays for services and supplies. The cons are fee-for-service doesn’t pay for all the costs. Some pros are there is more flexibility in choosing providers and you don’t need a referral to see a specialist, only some paperwork. Some cons are there may be coinsurance and you may have to pay the cost right away and then file a

By going to an in network physician I am eligible to receive my insurance company discount which will help to reduce my overall out of pocket cost for any services that are provided. This is particularly important to me for the plan that I have is a HDHP, which stands for high deductible health plan. This year’s minimum deductible for single person is $1,300. Which is the amount that I have to pay out of my pocket before my plan will begin to pay. However, my out of pocket cost don’t stop there. Once I meet my annual deductible of $1,300, I am still required to pay 10% of all cost. So it’s important to me to maximize every health care dollar that I spend. In fact, I am seeing more and more employer sponsored health plans move away from HMO and PPO based plans to HDHP/ CDHP plans. This was particularly prevalent in 2014 and 2015. Per article in Health Day, “More employers moving to high-deductible health plans and consumer cost-sharing is also like to increase by 5 percent in 2015.” The thought is that health-plan participants will become better health care consumers. In actually this is not happening, for consumers are choosing to forgo necessary care because of the cost

The United States being referred for specialties depends on the insurance plan (Mossialos, Wenzel, Osborn, Sarnak, 2016, pp. 171-177). Health Maintenance Organization (HMO) plans give access to certain healthcare organizations and physician within their network that have agreed to lower rates for their services. The individual must agree to these services to have services covered. All services will be coordinated by the primary care physician PCP. Medicaid coverage is also based on these principles. Preferred Provider Organization (PPO) plan have higher premiums but give more flexibility. PPO allows the individual to see any physician they choose but cost is less if the individual stays within the network. PPO does not require that the individual have a PCP. No referrals for specialist are needed.

Another example was being tasked while on OP SCORPION to apprehend a PPO who was wanted for theft. Having been informed via our intelligence briefings, I verified with their offender manager that the PPO had disengaged by dismissing all forms of contact. Due to this, I considered a range of options and decided to visit the PPO’s partner in order to establish his location. From speaking with her, I was able to co-ordinate a time for the PPO to present himself at the Police Station. Unfortunately the PPO did not appear. This change in circumstances led me to relentlessly pursue all known associates, addresses and other locations through prior knowledge of the PPO. Whilst performing these enquires, I located the partner using her vehicle close

Assuming that I am a healthy twenty two year old with only a 21,000 dollar income, the choice of having a lower premium every month is very much appealing! When looking at the grand scheme of life the overall expense of living is large, especially on that low budget income. In this case I would be influenced to go with a lower monthly premium plan like Priority Health - MyPriority HMO HSA Bronze 6550, the premium before a monthly tax credit would be 173 dollars and after the tax credit would be 42 dollars. The huge benefit to this would be that at the end of the year I would only be spending 504 dollars for health insurance and be able to put my funds to better use elsewhere, barring that at twenty two years old, I do not come down