Hcr-230/Week 1

There are many choices before picking Private payers or Consumer-Driven Health Plans. Private payers have plans such as PPO’s, HMO’s, and Group HMO’s, IPA’s, POS’s, and Indemnity plans. Consumer-Driven Health Plans are like a free will plans because a consumer can have options to build their own plans depending on their financial situation with saving account options. Learning about each health plan and identifying each feature, since there are many options available for health care coverage.

Private plans have different types of plans and products. Preferred Provider Organizations (PPO) is a discounted fee-for-services. Consumers pay an annual premium and a deductible. Co-pays are paid at time of services, and pay the yearly deductible out of pocket. Consumers need a referral for pre-authorizations to see a doctor out of network, or their deductible can be higher. Staying with in-network is a better option for consumers that have a PPO plan. (Valerius, Bayes, Newby, Seggern , 2008). Staff Health Maintenance Organization (HMO) is licensed by the state. It is a low cost HMO that strict guidelines and less provider choices. The consumer has to pick a physician within the network. The payer provides a primary care doctor and has to stay within network covered services. If the patient needs to see a specialist, it needs to be in the patient contracted medical group. If the consumer goes out of network, the HMO will not pay for any services and is left for the consumer. Emergencies are the only exception. Consumers pay co-pays and premiums for office visits. Under HMO, consumers do not have to pay out of pocket but may have to pay for a deductible. Point-of-Service (POS) plan is a hybrid of HMO and PPO networks. Consumers can choose where to receive services. They can go in or out of network. Premiums are more costly than other plans, but the benefit of seeing any medical provider without permission. Consumers have to pay higher co-pays and...