You Decide - Case Study HMO which stands for Health Maintenance Organizations are licensed health plans that place providers‚ as well as the health plans‚ with dealing with HMO’s there is a risk of medical expenses. The downfall with HMO is that patients must stay inside their network and if the go outside the network they will have to pay out of pocket expenses. HMO is very limited; many patients don’t like limitations when it comes to their decision about their health. PPO which stands for Preferred
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13‚ 2011‚ from kff.org: http://www.kff.org/healthreform/upload/8061.pdf Geselbracht‚ R Igel‚ L. (2008‚ 05). The History of Health Care as a . Retrieved 08 10‚ 2011‚ from net.acpe.org: http://net.acpe.org/MembersOnly/pejournal/2008/MayJun/Igel.pdf Indemnity Plans Institute‚ M. E. (2005‚ 6). Two Myths About the U.S. Health Care System. Retrieved 08 07‚ 2011‚ from iedm: http://www.iedm.org/uploaded/pdf/juin05_en.pdf Klein‚ P Obringer‚ L. A. (2006‚ 02 04). How Health Insurance Works. Retrieved 08 04‚ 2011
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In December 1998‚ Aetna announced that it would purchase Prudential Health Care from Prudential Insurance Company for $1 billion in cash and debt. The merger created the biggest healthcare company in the United States with 22.4 million customers (Freudenheim). In July of the same year‚ Aetna had just purchased NYLCare from New York Life Insurance to become the fourth largest managed-care company‚ and it was still in the process of integrating (3-99 CV 398-H). The Prudential Health Care merger was
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financial or coverage benefits for the consumer or the provider. Some of the similarities between the major health care options between the HMO organization and the POS organization are that both of these organizations require that a primary care physician manages the care. They also have lower copayments and cover preventive care. The HMO‚ Indemnity Plan and the PPO require preauthorization on procedures while all five
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access structure‚ such as gatekeeper‚ open-access‚ and so forth? How does the model affect patients? Include pros and cons. How does the model affect providers? Include pros and cons. Health maintenance organization (HMO) Example: HMOs first emerged in the 1940s with Kaiser Permanente in California and the Health Insurance Plan in New York. However‚ they were not adopted widely until the 1970s‚ when health care costs increased and the federal government passed the HMO Act of 1973‚ which required
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quality employees. Like the company‚ quality coverage is extremely important‚ but so is cost. Your Role The company has engaged your services to research several insurance programs. First‚ compare and contrast the differences between an HMO‚ a PPO‚ and an indemnity insurance program. From the list below‚ select and discuss at least one other important service that Cooper-Pearson should consider when selecting an insurance program. 1. Discuss the importance of managed-care physician credentialing
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and physician management organization are the normal Management Care Organizations. There are three essential kinds of managed care organizations: Health Maintenance Organizations‚ Preferred Provider Organizations and Point of Service plans‚ with PPOs being the most common of the three. Health Maintenance Organizations tend to be the most prohibitive type of the three. They essentially expect individuals to choose a primary care doctor‚ from whom a referral is required before receiving services
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delivery of health traditionally evolved around the individual relationship between the provider and patient/consumer. The payment was either provided by a health insurance company or paid out of pocket by the consumer. This fee-for-service system or indemnity plan increased the cost of healthcare because there were no controls on how much to charge for the providers service. As healthcare costs continued to spiral out of control throughout the decades‚ more experiments with contract practice and prepaid
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system has been continuously changed‚ resulting in the increased independent specialty practices and the growth of managed care plans (DeNavas-Walt‚ Proctor‚ & Smith‚ 2007). Such plans include Health Maintenance Organizations (HMOs)‚ Preferred Provider Organizations (PPOs)‚ and Point of Service (POS). Managed care plans are defined as health insurance plans that contract with health care providers and facilities to provide necessary and efficient health care for members at appropriate costs (MedlinePlus
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org). What is Managed Care? Managed Care is defined as “a system of health care in which patients agree to visit only certain doctors and hospitals‚ and in which the cost of treatment is monitored by a managing company” (www.google.com). “Gatekeepers” are designated and assigned various tasks of guiding members through a network of insurance plans designed to provide quality care at the lowest possible costs. Although Managed Care is known for its restrictiveness‚ it still covers an extensive
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