There are two principle choices between types of health insurance. They are a PPO and an HMO. PPO means a Preferred Provider Organization where HMO means a Health Maintenance Organization. Each has their advantages and disadvantages. Both will provide treatment after a serious semi-truck accident.
Health Maintenance Organizations:
An HMO is a network that is set up to address all medical needs. The network concept is important, because if your insurance plan is an HMO, all of your medical treatment will be handled within the network. Hospitals and physicians that are a member of your network have rules, standards and guidelines they follow to be a member of your treating network. There are virtually no opportunities to see a doctor that is not signed up or a member within your Health Maintenance Organization. This means if you want to see a specific doctor or specialist, most likely you will not be able to get medical treatment from them.
- There are a certain number of tests that are allowed.
- There are a certain number of visits allowed.
- You will be able to choose your primary care physician.
- If you need to see a specialist or get a specific type of treatment, you need a referral from your primary care doctor.
- If you want to visit someone outside of network, the HMO does not cover any form of payment. It is similar to not having insurance.
- HMO plans are cheaper and less expensive than PPO plans.
Preferred Provider Plans:
These plans provide more choice when picking doctors and specialists, but their monthly cost is higher. There is a network of providers, but you are not limited to only those doctors. The doctors in network have less of a co-pay (sometimes no co-pay), and have fewer restrictions on the number of visits and types of procedures that are allowed. While you can see doctors that are out of network, generally the co-pay for those doctors will be higher.
- You can see all doctors.
- You can see all specialists.
- If you go out of network, you can go (HMO can’t go out of network), but you will pay a
higher monthly cost.
- Generally the treatment is considered better under PPOs, but this isn’t usually true.
Comparison of HMO to PPO:
If you make a list of cost benefit analysis it will look something like this:
- Cheaper monthly premiums.
- Primary Doctor.
- Must get authorization to have a procedure or see a specialist from primary doctor.
- Cannot go out of network.
- There are sometimes limitations for smaller towns and more rural areas where HMOs are not effective (there is no HMO network in the area).
- More expensive.
- Can go to any doctor, whether in network or out of network.
- In network doctors or physicians will have less of a deductible.
- No pre-authorization to see a specific doctor.
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