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Health Care Providers Basic Facts

Todays Date: November 21, 2018

Employees today usually have a health plan provided by their respective companies. This is either from an HMO, Health Maintenance Organization or a PPO, Preferred Provider Organization. The third option is the POS or a Point of service plan. Here are some of the basic facts about HMOs and PPOs to help you figure out health insurance providers.

If you are enrolled in a Health Maintenance Organization then all of your health needs will be serviced by one provider. There are a network of hospitals, laboratories, clinics and pharmacies that you can avail of services from. You are also required to select a PCP or a Primary Care Physician who will be the one to manage your health needs and coordinate with hospitals and clinics on your behalf. A referral is needed from your PCP whenever you need to consult a specialist based in another hospital or clinic that is part of the network.

The PPO network will not require people to have a PCP if they are enrolled here. You can go to any clinic or hospital that is part of the network and you can choose your own doctor. You do not need any referrals and you only have to pay the annual deductible. If you go to a nonmember hospital or clinic then you need to pay more.

For payments in HMOs you will only need to pay for your prescriptions, doctor visits and procedures. Employees also need to pay their monthly dues together with their employers. Some PPOs have the option of allowing people to pay for an annual deductible for any medical services that you have to avail from non-accredited clinics and hospitals. It is great that PPOs can reimburse any health expenses as long as you have an official receipt from the said hospital. HMOs do not have option like this one so you have to go to an accredited hospital for your treatment.

You have just read some of the basic facts about HMOs and PPOs that provide health care insurance. Make sure that you choose a health care provider that will benefit you more and be suited to your health care needs.

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