| Most of the health services and financial issues related | | | | see specialists, for example a cardiologist, if this is first |
| to healthcare insurance policies are handled by what is | | | | authorized by the PCP. Without a referral HMO is not |
| called managed health care. This is one of the most | | | | responsible for the charges that specialist will ask for. If |
| common ways of providing healthcare coverage to | | | | you have signed up with an HMO, you will have to |
| people across the United States. Managed health care | | | | select a doctor listed on their providers list. If you |
| strives to provide the highest quality healthcare to its | | | | prefer someone else (for example a family doctor) |
| members, along with other additional benefits. | | | | you will have to select another care plan. |
| Managed health care ensures that the patients are | | | | PPO works almost in the same way an HMO does, |
| provided with healthcare in a most appropriate location, | | | | except that the patient does not have a PCP. PPO |
| close to their home or even inside their home if a | | | | forms a providers network just like HMO, but patients |
| patient is that much ill and needs constant care. In | | | | can also choose a doctor from outside that network. |
| addition to this, they also see to it that an appropriate | | | | However, the network is formed to give extra financial |
| provider is chosen to cater to the needs of the patient. | | | | incentives to its members. Keep in mind that PPO |
| These plans are composed of networks consisting of | | | | costs more than an HMO because of the flexibility in |
| only a limited number of doctors and healthcare | | | | choosing your doctor and the fact that you do not |
| professionals unlike other health insurance services. | | | | need referrals to see a specialist. |
| Mainly there are three types of managed care plans | | | | A POS plan is somewhat a combination of both PPO |
| available to customers: Health Maintenance | | | | and HMO. It is also called an open-ended HMO. The |
| Organizations (HMO), Preferred Provider Organizations | | | | patients or members are given the freedom of |
| (PPO), and Point-of-Service (POS) plans. The features | | | | choosing either a PPO service or an HMO service |
| and benefits offered by each of these plans differ | | | | depending upon their situation and the kind of |
| from one another. Also, there is a level of restriction | | | | healthcare they require. Sometimes seeing a specialist |
| found in each one of these plans. Before choosing a | | | | without a referral is very urgent and important. In such |
| managed care plan you need to carefully assess your | | | | a case the members can go with the PPO and pay a |
| situation. | | | | little extra fee. In other cases when only a general |
| An HMO has contracts with medical professionals and | | | | physician would be sufficient to provide the necessary |
| hospitals that offer discounts to their patients. The | | | | prescription, the members can go with HMO. Patients |
| patients or members are required to pay a monthly | | | | are also given the freedom of choosing their PCP if |
| fee, regardless of whether they see a doctor every | | | | they want to. These kinds of plans are becoming |
| month or not. They also have to choose their Primary | | | | increasingly popular because of the lack of restrictions |
| Care Physician (PCP) and always see him first before | | | | and flexibility they have to offer to their members. |
| going to other members of the provider network. PCP | | | | It is again encouraged that before jumping to one of |
| is also known as a gatekeeper. So if you come | | | | these managed care plans you should carefully |
| across this term on a membership form, do not be | | | | analyze your situation and the urgency of healthcare |
| surprised or worried. The patients will only be able to | | | | insurance. |