Health Plans 2019-03-03T09:57:24+00:00

We Have Access To Virtually Every Insurer in California

HMO

Health Maintenance Organization or HMO: HMOs limit their members to in-network healthcare providers except in the case of an emergency. To see a specialist, the patient must get a referral from their primary care physician. For certain treatments or services, the patient must get prior authorization from the insurer. Members in HMOs generally have no deductibles and pay minimal copays per visit. Per patient payments or capitation payments are fixed monthly payments regardless of how many visits the patient makes or the cost of the related treatments or services. The fixed monthly payments are due even if no care is rendered at all.

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PPO

Preferred Provider Organization or PPO: PPOs allow patients to seek medical care from in-network or out-of-network health providers; however, patients pay less when in-network providers are used. To see a specialist, the patient does not need a referral from a primary care provider. For certain services, patients, must obtain prior authorization from the insurer. Members of PPOs may be required to pay deductibles, copays, and co-insurance. PPOs are similar to indemnity plans in that both are paid by the fee-for-service method. In a fee-for-service plan, the medical service provider is paid a pre-set fee for each type or unit of service given. An office visit, laboratory tests, x-rays, or other services are paid individually according to a pre-determined fee schedule. This type of payment method enables health care providers to receive the maximum reimbursement for each service rendered.

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EPO

Exclusive Provider Organization or EPO: EPOs are similar to PPOs, but they are more restrictive. Patients are limited to in-network providers except in the case of emergencies. However, no referral from a primary care physician is required for the patient to see a specialist. Prior authorization is required for specified services and treatments. Patients may be responsible to pay for deductibles, copays, and co-insurance.

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POS

Point-of-Service Plan or POS: POS plans have features of PPO plans and HMO plans. POS plans allow out-of-network services, but the services may be limited, reduced, or not available. In-network services cost the patient less out of pocket. To see a specialist, the primary care physician must provide a referral. The insurer must give prior authorization for specified services. Patients may be responsible for deductibles, copays, and co-insurance.

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