Your ultimate insurance guide


 

Health and Medical Insurance - Comparing Managed Care Health Plans

Health insurance plans have been forced tostrategy is intended to avoid duplication of
take action to contain costs of qualityservices (for example, the cardiologist
health care delivery as health care costsordering tests that have already been done by
have skyrocketed. Health insurance premiums,the PCP, or a sprained ankle being referred
deductibles and co-pays have steadilyto an orthopedic) and avoid unnecessary
increased, and health insurance companiesspecialist referrals, tests and/or
have implemented certain strategies forprocedures.HMO and PPO plans also contain
reducing health care costs. "Managed care"costs by requiring prior approval, prior
describes a group of stratgies aimed atauthorization, or pre-certification for many
reducing the costs of health care for healthelective hospital admissions, surgeries,
insurance companies.There are two basic typescostly tests and imaging procedures, durable
of managed care plans; health maintenancemedical equipment and prescription drugs.
organizations, or HMOs, and preferredWhen such services are required, the provider
provider organizations, or PPOs. So whichmust submit a request to the health insurance
health plan is best? How do you choose whatplan review department, along with medical
type of health insurance best suits therecords that justify the service. The
health care needs of you and your family?Bothrequest is reviewed by the health insurance
HMOs and PPOs contain costs by contractingcompany to determine whether the services are
with health providers for reduced rate onjustified as "medically necessary" according
health care services for its' members, oftento the health plan policy and guidelines.
as much as 60%. One important differenceReview is usually performed by licensed
between HMOs and PPOs is that PPOs often willnurses, and, if the reviewer agrees that the
cover the costs of care when the provider isservice is necessary, approval is given and
out of their network, but usually at athe service will be covered by the health
reduced rate. On the other hand, most HMOsinsurance plan.As health care costs continue
offer no coverage for health care servicesto rise, many indemnity health insurance
for out-of-network providers.Both HMO andplans, or "fee for service" plans are being
PPOs also control health care costs by use offorced to adopt some managed care strategies
a gateway, or primary care provider (PCP).in order to provide quality health care and
Health insurance plan members are assignedkeep health insurance premiums affordable.
(or select) a primary care practitionerAnd as long as health care costs continue to
(physician, physician assistant, or nurserise, the distinctions among PPO, HMO, FFS
practitioner). usually a family practitionerand other health insurance plans will become
or internal medicine doctor for adult membersblurred. Rest assured, however, that managed
or a pediatrician or family care practitionerhealth care is here to stay.Kay Lowe holds a
for childern. The primary care provider isMaster's degree in health care and has 30+
responsible for coordianting health deliveryyears experience in the health care field.
for plan members. Care by specialistShe is also webmaster for
physicians require referral from the primaryHealth-Infosource.com, a website dedicated to
care provider. This cost containmentdisseminating health information.



1 A B C D 60 61 62 63 64 65 66 67 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111