Features of Private Payer & Consumer Driven Health Plans

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Individual Features of Private Payer and Consumer-Driven Health Plans

Individual Features of Private Payer and Consumer-Driven Health Plans

Looking for medical health plans can be demanding on time, but it is worth the time to look over all the options offered. There are many features to go through from Private Payer Plans, such as Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs), Group HMOs, Independent Practice Association (IPA), Point of Service (POS), Indemnity Plans, and Consumer-Driven Health Plans (CDHP) such as, Health Reimbursement Plans, and Flexible Savings Accounts, (Bayes, 2008). Bayes (2008) stated “PPOs are used by hospitals, physicians, clinics, and pharmacies that help provide care for their insured consumers.” The plan covers “discounts for fee-for services to the physicians to help with their fee schedules.” Patients or consumers are responsible for “annual premiums, deductibles” that generate from “low with high premiums or high with low premiums,” copayments, coinsurance which is a charge for in-net-work providers, services used for out-of-network will cause a higher deductable (p. 292, 293). Bayes (2008) stated that “HMOs are all licensed by the state”. Plan is strict on guidelines, has few choices of providers. The participating providers are salaried based. Coverage for consumers are given an “assigned Primary Care Physician (PCP)”, must use network providers to be covered, unless emergencies. Blue Cross Blue Shield of Michigan, (2011) states their “plan includes monthly rates, copayments, deductible, annual maximums, prescriptions, dental, and must be in network PCP” (Para. 4). Bayes (2008) stated that HMO programs included in plan are “complete preventative or screening, wellness and health promotion, disease management, and chronic care” (p. 293). Bayes (2008) stated that “Group HMOs are contracts with more than one physician group” mainly these are facilities owned by HMO and they can treat...
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