10. Hermer, L. (2013, September 1). PRIVATE HEALTH INSURANCE IN THE UNITED STATES: A PROPOSAL FOR A MORE FUNCTIONAL SYSTEM. law.uh.edu. Retrieved September 1, 2013, from www.law.uh.edu/hjhlp/Issues%5CVol_61%5CHermer.pdf…
Preferred provider organizations (PPOs) are a private plan which is the most popular, followed by health maintenance organizations (HMOs). PPOs sometimes pay participating providers based on a discount from their physician fee schedules which is called a discounted fee-for-service. With a PPO the patient pays annual premiums and often a deductible. The patient has two choices with the first being offered a low deductible with a higher premium and the second being a high deductible with a low premium and they always pay a copayment at the time medical services are rendered. Consumer-driven health plans (CDHPs) combine two components with the first being a high-deductible…
The purpose of a managed care organization is to coordinate the costs and delivery of health care. A managed care organization oversees money spent on labor, technology, and facilities such as physician offices and hospitals. A type of managed care organization is a Health Maintenance Organization (HMO). A HMO “provides medical care for all its enrollees in return for a fixed annual fee per enrollee” (University of Phoenix, 2010, Key Terms and Concepts Section). An HMO tightly oversees the use of health care services thereby reducing costs and controlling utilization. For example, HMO’s…
This health insurance provision lets your insurer make direct payments to your doctor or hospital A. assigned benefits…
There are several ways the managed care model is expressed one particular way is the Health Maintenance Organization or better known as HMO. HMOs have their own network of doctors, hospitals and other health care providers who have agreed to accept a payment plan at a certain level of services they provide. With HMO, you would have to pick a Primary Care Physician within the local approved network where that doctor can coordinate any additional care you might need. If you need a specialist, a referral would be needed within the HMO network. HMOs usually have lower monthly premiums, but out of network health care professionals are not typically covered by the insurance.…
Some of the pros for managed care are; Preventive care — HMOs pay for programs, they are set up and are intended at keeping one healthy (yearly checkups, gym memberships, etc.)The idea is, so they won 't have to pay for more costly services when and if one gets sick. Lower premiums — Because there are limits set as to which doctors one can see and when one can see them, HMOs charge a premium and usually they are lower premiums. Prescriptions — As part of their precautionary retreat, most prescriptions are covered by HMOs for a co-payment that also can be very low. Fewer unnecessary procedures —doctors are given financial incentives from HMOs , to provide only needed care, so doctors are less likely to order costly test or surgeries that one does not need. Limited paperwork — While healthcare professionals and facilities have more paperwork, under managed care, HMO members usually only has to show their membership card and pay a very low co-payment.…
The pros of managed care are since the patient is limited to a specific caregiver the premium is lower. The patient only pays a monthly payment and a co-payment. The cons of managed care are that the patients are not allowed to see the doctor of their choice unless the doctor is in their network. The consumers perspective the pros and cons of managed care. The pros from the consumers perspective would be only paying monthly payments that is at a fixed rate. The other would be paying a small co-payment every time they see a doctor. The cons of managed care from a consumers perspective would be that they cannot see the doctor of their choice. The caregiver has to be affiliated with the managed care organization. The pros and cons from a caregivers perspective. The pros would be stability, fewer administrative duties, and better working hours. The cons would be less independence, and possibly a decrease in the income. There are more pros and cons these are just a few of them. From a caregivers perspective they would rather the patient have traditional insurance. The reason for this is because the caregiver is losing money by the patient having managed care. Caregivers get a percentage of the money when they see a patient with traditional insurance. Then there is also more stability and less working hours for the caregiver with managed care. It would be like flipping a coin for the caregiver what would they rather have more money or more time to spend with their family. The consumers perspective it would be in their best interest to have one of the managed care options (HMO,PPO). The reason for this answer is because for the most part most consumers…
Health care is always going to be an important issue, especially when much of the population does not have coverage for one reason or another. A series of surveys were conducted in 2010 in Central Texas by the Central Texas Sustainability Project (CTSIP) to find out who had health coverage. They also asked follow up questions to those who do not have health care coverage to get the reasons why and to determine trends in their data.…
During this year, most American receives their health coverage through the private insurance market, usually through their jobs. Many people buy their own insurance in individual market. Private health coverage products pool the risk of high health care costs across a large number of people, permitting them (or employers on their behalf)…
Managed care has been formed since the 1930 and evolved over the last ten years. Since the evolving of managed care there are three types of managed care plans. People that are enrolled in private health insurance are subscribed to a type of managed care plan. There are many differences between the three types of managed care plans and they also have similarities. The involvement of managed care plans are between the insurer and the selected network of health care providers, and the policyholder’s financial incentive that are used by the providers in the network. There are precise measures for choosing a managed care plan and conventional procedures to acquire quality care (Types of Insurance, 2010).…
Managed care is any arrangement in health care in which an organization like HMO or…
To begin with, the majority of insurance companies are privately owned and this allows companies to set their own rules and causes health insurance to become unaffordable. First, companies “maximize premiums and…
PPO- Preferred Provider Organization allow visits to innetwork doctors or healthcare provider with out a referral…
are the benefits of providing a premium plan worth $6,720 more per year per individual? These are the types of decisions that companies are having to make. They have to weigh the marginal costs with the marginal benefits. When you look at this information as a rational decision maker one can reason that it is not worth paying the 40% tax. Meaning that since the marginal benefits do not outweigh the costs companies are deciding to do away with the premium plan and look for one that meets the government’s thresholds.…
Healthcare today is a big issue for a lot of individuals, and families. Because it’s not affordable and some plans are lacking the necessary coverage people need these days. There are many ways to make healthcare more affordable, adequate, efficient, and patient-centered. That being said there are also various healthcare plans that are suited for many different people such as HMO’s, PPO’s, POS’s, Medicaid, and Medicare. This is why government should develop a reform plan that focus on all of the above issues and much more.…