Hmos and Ppos

Topics: Preferred provider organization, Health insurance, Health maintenance organization Pages: 1 (422 words) Published: June 2, 2013
Health Maintenance Organizations
If you are enrolled in a health maintenance organization (HMO) you will need to receive most or all of your health care from a network provider. HMOs require that you select a primary care physician (PCP) who is responsible for managing and coordinating all of your health care. Your PCP will serve as your personal doctor to provide all of your basic healthcare services. PCPs include internal medicine physicians, family physicians, and in some HMOs, gynecologists who provide basic healthcare for women. For your children, you can select a pediatrician or a family physician to be their PCP. If you need care from a physician specialist in the network or a diagnostic service such as a lab test or x-ray, your primary care physician (PCP) will have to provide you with a referral. If you do not have a referral or you choose to go to a doctor outside of your HMO's network, you will most likely have to pay all or most of the cost for that care. (http://healthinsurance.about.com/od/understandingmanagedcare/a/HMOs_vs_PPOs.htm) Preferred Provider Organizations

A preferred provider organization (PPO) is a health plan that has contracts with a network of "preferred" providers from which you can choose. You do not need to select a PCP and you do not need referrals to see other providers in the network. If you receive your care from a doctor in the preferred network you will only be responsible for your annual deductible (a feature of some PPOs) and a copayment for your visit. If you get health services from a doctor or hospital that is not in the preferred network (known as going "out-of-network") you will pay a higher amount. And, you will need to pay the doctor directly and file a claim with the PPO to get reimbursed. (http://healthinsurance.about.com/od/understandingmanagedcare/a/HMOs_vs_PPOs.htm) In my area I did not find any HMO providers, but did find a few PPO providers, which are listed: Kevin Leroy Preston, Kevin Jay Liudahl, MD, Julie...

References: http://www.healthcare.com/insurance/phcs-ppo/IA/sioux-city/page-5/
http://healthinsurance.about.com/od/understandingmanagedcare/a/HMOs_vs_PPOs.htm
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