PPO and POS Health Insurance
The last decades have seen the growth of new more innovative types of health insurance. The more traditional monthly premium plans have gradually been replaced by methods such as preferred provider organizations (PPOs) and Point-of-Service (POS).
Preferred Provider Organizations
Preferred provider organizations involve the specific arrangements between insurance companies and a network of health care providers. It is one step more complicated than managed care as the arrangements involve much lower prices for the policyholders.
The financial incentive is quite attractive for members. For example, if you go to a specialist within the network you might be required to pay 10 % co-pay. However, if you go outside the network you might be required to pay the whole bill. Then, you will be able to get reimbursed for up to 80% of the original bill. You might also be required to pay a deductible or cover the charge difference in case you opt for out of the network provider.
One benefit of using the network of medical specialist is that in most case you do not need approval and you can refer yourself to the doctor you need. This means that there will be less paperwork and expenses for you. Further, there are more comprehensive PPOs that exclude any kind of service given by outside providers. Thus, you are obliged to pay the whole expense of using a doctor outside the network.
Point-Of-Service
POSs are more complicated than PPOS in that they also have a gatekeeper. He is called the primary care physician and must be selected among the preferred list of the network. In case of a problem you have to visit the physician who will give you a referral to a specialist. In case this specialist is one of the network the primary care physician will make sure than the insurance company covers your expense.
You still have the choice to go to a provider outside the network. However, this will entail more hassle and paperwork. Also, you might be required to pay a deductable or cover the whole cost and then be partially reimbursed.
An advantage of this kind of systems is that it includes preventive care and health improvement programs. Your primary care physician might refer you health clubs, anti addiction programs etc. that will be covered by your insurance company.
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