Health Insurance Plans- Insurance Systems
HMO Health Insurance Plans
The HMO Health Insurance Plan is considered
the most affordable system. The insured has to select a Primary
Care Physician (PCP) doctor from the plan’s directory. The PCP has
the authorization to refer patients to specialists, hospitals and other
service providers. If a patient seeks a service without the PCP authorization
he/she may end up paying a very high cost for this service, as the insurance
carrier may not cover it.
lower cost for major health services.
- Good HMO
system has the fine balance between cost and services.
- Most billing
and payment matters are provided by the health providers and are taken care of by the HMO management.
There is no need for frequent contact between the insured and the insurance
are not required to check first before each office visit if their PCP is with in the Insurance
"IN NETWORK" directory. If the PCP office is terminating the relationship
with the insurance company, they tend to notify the insured with the
health services. Insurance carriers tend to exclude high priced services
and new drugs from the HMO systems.
cannot see a specialist without the PCP authorization. This process
is not always in the best interest of the patient.
- The "IN-NETWORK"
doctors’ directory is changing frequently. Insured may not be
able to get service from the same doctor for a long time. Doctors may
choose not to participate with the HMO "IN-NETWORK" system if it pays
less than the PPO plans.
PPO (Preferred Providers Organization) Health Insurance Plans
The PPO Health Insurance Plan is
a system that allows insured to choose their doctors and health facilities.
The monthly premiums are typically higher compared to HMO plans, but it
has major advantages over the HMO system. As with the HMO, the IN-NETWORK
doctors and services are the most cost effective.
are free to choose their doctors and health care facilities from the
PPO IN-NETWORK directory.
- Most doctors
prefer to work with PPO networks, their contacts with the health insurance
companies paid more compared to the HMO.
- More drugs
and high priced services are covered under the PPO system.
- The fact
that insured can choose their doctor may save them time and money by
getting service from specialists at the time of need.
have to deal directly with their health insurance and service providers
for billing issues. It takes time and effort to manage all the payment
is required to check with Provider before each office visit to verify if the healthcare provider
accepts their insurance. In case the service will not be covered, or
the service provider was OUT-OF-NETWORK, it may result in higher
- PPO monthly
premiums typically cost more compared to the HMO plans.
Serving these areas: CA, DC, FL, MD, NJ, NY, PA, TX, VA, WA