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Managed Care Plans Essay

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Types of Managed Care Plans… • Health Maintenance Organizations (HMOs) • Preferred Provider Organizations (PPOs) • Point-of-Service Plans (POS) Health Maintenance Organizations (HMOs)… If you are enrolled in a health maintenance organization (HMO) you will need to receive most or all of your health care from a network provider. HMOs require that you choose a primary care physician (most often an internist, family doctor, or pediatrician for your children) who is responsible for managing and coordinating all of your health care. If you need care from a physician specialist in the network or a diagnostic service such as a lab test or x-ray, your primary care physician (PCP) will have to provide you with a referral. If you do not have a referral or you choose to go to a doctor outside of your health plan’s network, you will most…show more content…
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. Point-of-Service Plans (POS)… A point-of-service (POS) plan is a combination of a health maintenance organization and a preferred provider organization. Typically, POS plans have a network that functions like a HMO – you pick a primary care doctor, who manages and coordinates your care within the network. POS plans also allow you to use a provider who is not in the network. However, if you choose to go out-of-network for your care, you will pay more. These plans are known as point-of-service, because each time you need health care (the time or “point” of service), you can decide to stay in the network and allow your PCP to manage your care or go outside the network on your own without a referral from your
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