Hsm 546 You Decide 1

Topics: Health care, Preferred provider organization, Managed care Pages: 2 (699 words) Published: February 1, 2013
I have been asked by Cooper-Pearson to research different medical insurance plans that they could consider as one of their selected insurance programs for their marketing company. My goal is to provide them with enough details in order for the company to make an informed decision as to which program they would like to consider. This information will allow them to provide their employees with an effective compensation package that is both affordable and desirable and I believe that once an attractive compensation plan is in place; we should expect the retention rate of the company to improve and the recruitment of quality employees to increase as well. First I will start by demonstrating the comparison and contrast between an HMO plan and a PPO plan. The HMO plan requires participants to have a primary care physician with the network and the participant does not have the option of visiting a physician outside of the network. They must be referred by the primary care physician to see a medical specialist and the specialist must be within the approved network, the plan normally costs less than the PPO plans, however the co-pay is significantly high. On the other hand, the PPO provides its participants with more information concerning the cost of sharing providers in and out of the network (Kongstvedt, 2007). The PPO commonly negotiates a lower overall fee arrangement with physicians, hospitals, clinics and other health care providers. For this reason; utilization management is another common characteristic of PPO so that they are able to control the cost of health care. With that being said, PPO allows participants to make their own opinion as to whether or not they would like to be covered by network providers or non-network providers. If the participant chooses to go outside of the network for services, their cost sharing rate will increase compared to those participants that choose to stay with the network services. More so, with the indemnity plan, participants...
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