Health Care Plan For Healthcare Care

PPO- This plan contracts with physicians and facilities to perform services and a specified rate. Its to ensure that PPO members are charged less than nonmembers

Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations

Another type of managed care program that was introduced is the Preferred Provider Organization (PPO). A PPO is comprised of a group of physicians, hospitals and other medical service providers who contract with employers, insurance companies or other plan sponsors. The PPO offers discounted pricing to these contracted organizations due to the high volume of business received. PPO’s typically have up-front cost sharing in the form of deductibles and/or co-insurance, which vary depending upon the actual plan chosen.

Preferred provider organizations have also contracted with hospitals and physicians to provide health-care services. Unlike the case with an HMO, you do not have to go to these physicians. However, you will pay more if you go outside the list of preferred providers. PPO plans usually have a deductible, which is the amount that the insured must pay before the PPO begins to pay. When the PPO plan does start to pay, it will usually pay a percentage of the bill and you have to pay the remainder, which is called “coinsurance.” Most plans have an out-of-pocket maximum. This helps protect you from paying more than a certain amount per year. After you exceed the out-of-pocket maximum, the coinsurance percentage paid by the PPO increases to 100%. (www.ajmc.com)

A preferred provider organization (PPO) plan gives patients the flexibility to see providers and specialists within or outside the network of care; it will typically cost less to receive care from an in-network provider (U.S. Centers for Medicare & Medicaid Services, n.d.). In most cases, referrals for specialists and designating one physician as a primary care provider is not required of a PPO plan. (U.S. Centers for Medicare & Medicaid Services, n.d.). Alternatively, a health maintenance organization (HMO) limits patients to receive care from doctors, specialists, and hospitals covered under the health plan (U.S. Centers for Medicare & Medicaid Services, n.d.). With the exception of emergency can and out-of-area urgent care, all care providers

Americans that are insured receive their health care from managed care plans that are either HMO’s or, PPO’s (Preferred Provider Organizations). Most Americans are forced into managed care by their employers due to companies offering one managed care option or, worse no insurance at

HMO stands for “health maintenance organization,” and under this plan, you have certain types of restrictions that limit your care outside the network. For example, your number of visits and tests might be limited. HMO plans require you to pick a primary care physician who helps you decide on a treatment. Unfortunately, you typically cannot use HMO plans outside of the network, but your premiums are lower than other plans.

HMOs are a type of MCO that requires a PCP and the patient can only see their PCP, no care is covered including specialist care if it is outside the network. These thing help keep cost down. HMOs have two sub groups, the staff model and the group model. The staff model were the HMO owns the health care facility and pays the providers a salary, all care under this plan must be done in network (all owned by the HMO). The group model In the HMO system has a contract with a health care facility and the facilities providers and there is an agreement that the providers in the network that will only see the HMO’s patients. Then, there is the open panel where in this system providers agree to be PCP providers for a HMO and can also see other patients. The network model is when there is an agreement with healthcare facilities to accept the insurance and see the patients. The final type of HMO plan is the Independent Physician Association (IPA), the provider is paid an agreed price for the services and they see a high number of patients. Now to look at the PPO plans, for these plans contracts are made with providers for them to provide care to the patients as a preferred provider in the network. The providers agree to see the patients at their own office and are paid the agreed upon price for their services. There is no PCP or

HMOs provide medical treatment on a prepaid basis, which means that HMO members pay a fixed monthly fee, regardless of how much medical care is needed in a given month. In return for this fee, most HMOs provide a wide variety of medical services,

Health maintenance organizations HMOs - Members must have a PCP who is your general doctor, internist, OB/GYN, or pediatrician. PCP also coordinates cares and makes referrals to specialists. Their main concerns preventive care with a goal of containing overall healthcare cost. It only pays for services performed by in-network provider.

If you get health services from a doctor or hospital that is not in the preferred network (known as going "out-of-network") you will pay a higher amount - perhaps a coinsurance of 20% or more. And, you will need to pay the doctor directly and file a claim with the PPO to get reimbursed.

A PPO is a preferred provider organization. A type of health plan that contracts with medical providers,

Managed care is the most dominant healthcare delivery system in the United States and available to most Americans. Employers and government are the primary financiers of managed care. The managed care sector includes approximately

HMO (Health maintenance organizations), POS (point-of-service), and PPO (preferred provider Organization) are all different varieties of plans that all the various health insurance companies offer. Each plan offers different services. An HMO would be the least expensive and therefore have the least amount of benefits and care has to be done by network providers that are in the network unless it is an emergency and you are required to get referrals to see specialists. An PPO has a larger network than an HMO; and people can go to out of service providers and receive some benefits and there is no requirement for referrals to see specialists. A POS is a combination of HMO and PPO; you can go out of network but you need a referral if you don’t want

The managed care plan coordinates the financing and delivery of health care services of its members in order to provide the highest quality services at the lowest possible cost. These providers form the plan network. The network have rules that determine the amount of coverage your plan will pay. Restrictive plan cost less than flexible ones. HMOs pay provider within their network. Most patient's care is provided y a practitioner. PPOs pay provider within their network, but also pay provider outside their network. POS plans allow the insured to choose between an HMO or a PPO each time care is required (MediLexicon International Ltd, 2015).