| Health insurance is offered in various
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| | than given for network providers. HMOs
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| forms today. Traditionally, health
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| | usually offer no coverage for
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| insurance plans were indemnity plans; the
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| | out-of-network health care
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| insured paid a premium, the physician
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| | providers.Advantages of HMO/PPO plans
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| provided health care services, the health
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| | typically include lower health insurance
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| insurance plan was billed, and the health
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| | premiums than those of traditional health
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| insurance plan paid for covered services.
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| | insurance plans. HMOs and PPOs often
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| As health care costs became
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| | offer coverage for preventive and health
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| astronomical, health insurance companies
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| | maintenance care not covered by indemnity
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| developed different plans that were aimed
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| | plans. The health plan member is usually
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| at providing quality health care at
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| | not required to file claims for health
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| affordable prices. Managed health care
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| | care services; contract providers bill
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| became the buzzword for the health
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| | the health insurance plan
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| insurance industry, and health insurance
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| | directly.Disadvantages of these managed
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| plans became more complicated.Health
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| | health care plans include limiting
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| maintenance organizations, or HMOs, and
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| | coverage to providers in the health care
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| preferred provider networks, or PPOs,
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| | plan. Plan members must change primary
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| have largely replaced the traditional
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| | care providers if their provider is not
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| indemnity health plan. HMOs and PPOs
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| | in the health plan network. Many members
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| utilize strategies to contain health care
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| | do not want to change health care
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| costs. These health plans are similar in
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| | providers. Another disadvantage is that
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| certain ways. Both HMO and PPO plans
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| | prior approval/authorization processes
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| contract with health care providers to
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| | can be time-consuming and slow down the
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| provide health care services at reduced
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| | delivery of needed health care services.
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| rates for the health insurance plan
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| | Specialty health care can only be
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| members. Typically both plans require
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| | accessed through referral from the PCP.In
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| the the member have a primary care
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| | summary, HMOs and PPOs offer lower
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| provider, or PCP, who serves as a
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| | premiums and increased coverage, but
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| "gateway" to coordinate care for the
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| | limit members to their network of
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| member, and all specialty services are
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| | providers. Indemnity plans allow the
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| accessed by referral from the PCP. Both
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| | member to see the health care provider of
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| HMOs and PPOs require that certain
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| | their choice, and to access specialty
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| services and products, usually the more
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| | care when they want, but usually pay
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| costly ones, be reviewed by the health
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| | higher premiums for health insurance
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| insurance reviewers for prior approval or
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| | coverage. Ultimately the health plan
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| prior authorization before the service is
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| | member must decide whether choice of
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| rendered. The health care provider must
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| | physician and access to specialty care
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| submit justification for these services
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| | are worth the higher premiums. Whatever
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| as "medically necessary", and the
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| | plan is chosen, it is vital for members
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| reviewer determines whether the service
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| | to know their health insurance plan,
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| is a covered service. The plans do make
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| | including what services are covered and
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| provision for emergency situations that
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| | what providers are in network.Kay Lowe
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| cannot wait for prior approval
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| | holds a Master'd degree in health care
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| authorization, but still require an
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| | ahd has 30+ years in the health care
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| approval process.HMOs and PPOs differ in
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| | field. She is also webmaster for
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| significant ways, however. A PPO plan
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| | Health-Infosource.com, a website
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| often covers services rendered by
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| | dedicated to disseminating health
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| providers that are not in the plan
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| | information.
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| network, though usually at a lower rate
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