Today I
would like to explain the network types most commonly known as EPO’s, PPO’s,
HMO’s and POS plans. Some plan
types allow you to use almost any doctor or health care facility. Others limit
your choices or charge you more if you use providers outside their network. You
can easily identify the type of plan by looking at the description next to the
plan name.
Let’s look at each network type. http://www.SFCheapInsurance.com
·
Preferred
Provider Organization (PPO): PPOs
give you the choice of getting care from in network or out-of-network providers.
You pay less if you use providers that belong to the plan’s network. You’ll pay
more if you use doctors, providers, and hospitals outside of the network, and
you may have higher out-of-pocket costs for services. If you have a PPO plan,
you can visit any doctor without getting a referral.
·
Exclusive
Provider Organization (EPO): A managed care plan where services are covered only if you
use doctors, specialists, or hospitals in the plan’s network (except in an
emergency). No referral is required to see a specialist
·
Point
of Service (POS): A type of plan
where you pay less if you use doctors, hospitals, and other health care
providers that belong to the plan’s network. POS plans require you to get a referral
from your primary care doctor in order to see a specialist.
·
Health
Maintenance Organization (HMO): A type of health insurance plan that usually limits
coverage to care from doctors who work for or contract with the HMO. An HMO generally
won’t cover or has limited coverage for out-of-network care except in an
emergency. If you use a doctor or facility that isn’t in the HMO’s network, you
may have to pay the full cost of the services you get. HMO members usually have
a primary care doctor and must get referrals to see specialists.
We’ve been talking so much about provider networks, SO what is
that?
Well, a provider network is a list of the
doctors, other health care providers, and hospitals that a plan has contracted
with to provide medical care to its members. These providers are called
“network providers” or “in-network providers.” A provider that hasn’t
contracted with the plan is called an “out-of-network provider.”
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