Hmo and Ppo

Week 2 case study

Date: 11/9/12

Subject: HS 546

Difference between HMO , PPO and Indemnity care

In general, there are two main types of HEALTH INSURANCE PLANS: indemnity plans and managed care plans. Indemnity plans are the more expensive of the two because you have a lot of freedom to choose your health care providers. These health insurance plans typically feature high co-pays and high deductibles. Preventative care, mental health care, prescription drug coverage, vision care, and dental care are usually excluded from indemnity plans unless added on.

Managed care is the most common type of health insurance these days. There are many different levels of managed care, and some plans incorporate features of indemnity coverage to add flexibility. Managed care plans include health maintenance organizations (HMOs), point of service plans (POS), and preferred provider organizations (PPOs). Typical characteristics of managed care health insurance include low co-pays, low deductibles, and a network of preferred or mandatory health care providers. Preventative care, prescription coverage, mental health care, vision care, and dental care are often included in the coverage. Some managed care plans, however, require pre-authorization of services.

Benefits of physician credentialing

As a physician, it is essential for you to be credentialed and be in par with several prominent insurance carriers. You have to add this on top of your task list to improve your practice performance and serve your patients in a better way. Just like taking up professional licenses or buying a new machine for clinical procedures, getting credentialed is also an essential requisite to run a smooth practice with minimal risks. There are companies that provide physician credentialing services. You can save time and reduce the paper work by outsourcing the work to them.

Better payment: Insurance carriers pay better to the...