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Features of Private Payer and Consumer-Driven Health Plans

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Features of Private Payer and Consumer-Driven Health Plans

Page 1 of 5
Features of Private Payer and Consumer-Driven Health Plans
The following reading is to familiarize the reader with private payer plans and types of consumer-driven health plan (CDHP) accounts. Private payer plans such as PPOs, HMOs, and Group HMOs are the most popular but there are also others to consider when making decisions on health coverage, which are IPAs, POSs, and Indemnity plans. The CDHP accounts are made “for the consumer” and therefore consumers (patients) have a say in what kind of plan they wish to have and sometimes consumers can build their own health plan according to their financial situations with savings account options. After reading this information, the reader will have a clearer idea of the options available through health care coverage. Preferred provider organizations (PPOs) are based on membership to a specific health care provisions arrangement. As part of the PPO, the provider participates in this arrangement providing patients with services guided by discounted fee-for-service. This type of service is at a discount from their normal physician fee schedules. Other features of this plan include either a lower premium and higher deductible or visa versa. Copayments are also included in this plan and there could be an annual out-of-pocket deductible. Patients also have the choice of their providers although out-of-network providers will cost more on the patient’s part than provider’s in-network. One thing to remember though is that all non-emergency services require pre-authorization (Valerius, J., Bayes, N., Newby, C., & Seggern, J. (2008). According to WiseGEEK.com, “Most PPOs have a preferred provider list, much like the HMO provider list. Usually, seeing someone on the list means less expense. In fact, the PPO basically has an HMO component and network built into it” (para.6). Health maintenance organizations (HMOs) are state licensed and therefore are a lower cost health plan. Of course, because of less expense there are guidelines...

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