Private Payer and Cdhp

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Features of Private Payer and CDHP
Danielle Waymire
September 30, 2012
Beth Schalm

Private Payer and CDHP
Concerning medical insurance, there are several types of Private Payer and Consumer-Driven Health Plans (CDHP). These types of insurance plans are PPO, HMO, Group HMO, IPA, POS, Indemnity, and CDHP. Sometimes an employer will set up health savings accounts for plans with high deductible’s called Health Reimbursement Account or Flexible Savings Account.

Preferred Provider Organization(PPO) is a, “managed care organization of medical doctors, hospitals, and other health care providers who have covenanted with an insurer or a third party administrator to provide health care at reduced rates to the insurer’s or administrator’s clients “(“PPO Insurance”, 200-2012). A PPO plan member does not require a referral and can schedule own appointment if seeking treatment from a specialist, can see any doctor or facility without going to PCP first, and members pay an annual deductible. A member is covered for in-network and out-of-network services. Services in network, a member only required to pay copayment or deductible. Services rendered out-of-network, member is responsible for full amount unless deductible has been fulfilled.

Health Maintenance Organization (HMO) members are required to choose their primary care physician (PCP), obtain referrals from PCP, and are required to visit their hospitals. HMO’s are services paid on a prepaid basis for a fixed period. For the most part, HMO’s reduce cost in that many do not cover services outside the network unless the patient has an emergency or is traveling. In network services charge a copayment for doctor visits and services such as prescriptions or procedures. Out of network services are generally not covered.

Group HMO plans are provided by an employer and offers affordable coverage but, does limit where members receive care. Group HMO focuses heavily on preventative care to keep members...
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