Health insurance is offered in numerous forms today. Historically, health insurance plans were indemnity plans; the insured paid a premium, the physician provided health care services, the health insurance arrange was billed, and the health insurance plan obtained lined services. As health care costs became astronomical, health insurance firms developed totally different plans that were aimed toward providing quality health care at affordable prices. Managed health care became the buzzword for the health insurance trade, and health insurance plans became more complicated.
Health maintenance organizations, or HMOs, and most popular supplier networks, or PPOs, have largely replaced the traditional indemnity health plan. HMOs and PPOs utilize ways to contain health care costs. These health plans are similar in sure ways. Both HMO and PPO plans contract with health care suppliers to supply health care services at reduced rates for the health insurance plan members. Typically each plans need the the member have a primary care supplier, or PCP, who is a "gateway" to coordinate look after the member, and all specialty services are accessed by referral from the PCP. Each HMOs and PPOs require that bound services and product, usually the more pricey ones, be reviewed by the health insurance reviewers for previous approval or previous authorization before the service is rendered. The health care provider must submit justification for these services as "medically necessary", and therefore the reviewer determines whether or not the service is a covered service. The plans do create provision for emergency things that can't watch for prior approval/authorization, but still need an approval process.
HMOs and PPOs differ in important ways, however. A PPO set up often covers services rendered by providers that are not in the arrange network, though sometimes at a lower rate than given for network providers. HMOs sometimes offer no coverage for out-of-network health care providers.
Advantages of HMO/PPO plans usually include lower health insurance premiums than those of traditional health insurance plans. HMOs and PPOs often provide coverage for preventive and health maintenance care not covered by indemnity plans. The health plan member is typically not required to file claims for health care services; contract suppliers bill the health insurance plan directly.
Disadvantages of these managed health care plans embody limiting coverage to suppliers within the health care plan. Plan members should change primary care providers if their provider is not within the health set up network. Several members don't want to alter health care providers. Another disadvantage is that prior approval/authorization processes can be time-consuming and hamper the delivery of needed health care services. Specialty health care can only be accessed through referral from the PCP.
In summary, HMOs and PPOs supply lower premiums and increased coverage, but limit members to their network of providers. Indemnity plans permit the member to work out the health care provider of their choice, and to access specialty care when they need, however usually pay higher premiums for health insurance coverage. Ultimately the health plan member should decide whether selection of physician and access to specialty care are value the upper premiums. No matter arrange is chosen, it is important for members to know their health insurance set up, as well as what services are coated and what providers are in network.
Author Resource:
Riley Jones has been writing articles online for nearly 2 years now. Not only does this author specialize in Health, you can also check out his latest website about:
![[Valid RSS feed]](http://www.look4articles.com/images/icon_Rss.png "XML Feed For RSS"){kind=icon}
Category Rss Feed
Print This Article
Add To Favorites
![[Valid RSS feed]](http://www.look4articles.com/images/rss.jpg "XML Feed For RSS")