Health insurance today are offered in different formats. Traditionally, health insurance plans were credit plans; the premium for the insured, the doctor provided health care services, health insurance plan was billed and paid for services covered by the health insurance plan. Since the reimbursement of health care, health insurance, became the Astronomical, the companies developed different plans, which was intended to provide high-quality health care at an affordable price. Managed health care became the buzzword of the health insurance industry and the health insurance plans became more complex.
Health maintenance organizations, or HMOs, and PPOs or networks, the primary vendor, to a large extent replaced the traditional credit health plan. HMOs and PPOs customer strategies to curb the costs of health care. Health plans are similar in a particular way. HMO and PPO plans, arrange for health care providers of health services at a reduced rate of duty to provide for the health insurance plan members. Usually, for both of the plan is to require a member of the primary care provider (PCP), which acts as the "gateway" to coordinate care, and all of the specialty services, Member of the can use PCP referral. HMOs and PPOs, require that certain of the services and products, usually in the more costly ones can be checked for health insurance, the reviewers, or the prior approval of the system of prior authorisation before the service has been performed. The health care provider must provide a justification for these services are "medically, as appropriate," and the reviewer is to determine whether the service is covered by the service. The plans provide for emergency situations, which are not expected to permit approval in advance, but still require the approval process.
HMOs and PPOs differ significantly in different ways, however. PPO plan often covers players who are not in the network design, although usually more slowly than a specific network providers for services rendered. HMOs usually offer a network of health care providers no coverage.
HMO/PPO plans in the interests of the health of the child is usually the insurance premiums than those of traditional health insurance plans. HMOs and PPOs often offer prevention and health maintenance are not covered by the credit coverage plans. Health plan member is usually not required to file the claim on the health-care services; the providers of health insurance plan to bill you directly.
The disadvantages of managed health care plans, providers, limiting the coverage to contain health-care plan. Plan members will need to change primary care providers, if the provider is not health plan network. Many members do not want to change the health care providers. Another disadvantage is that, in advance, subject to the approval of the licensing process can be time-consuming and slow down the delivery of necessary services. Specialty health care can only be accessed through the referral to the PCP.
In summary, the HMOs and PPOs to offer lower insurance rates and coverage increased, but their network providers, the members of the border. Credit plans to allow Member States to See their health care provider and uses the specialty care, when they want to, but usually costs in the health insurance coverage at higher premiums. Ultimately, health plan, Member States shall decide whether the doctor and the specialty for the treatment of access to the dialog supports higher commissions. The plan whatever is chosen, it is necessary to know their health insurance plan, including what services are covered and what providers are members of the network.
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