Hcr230 Week 1 Assignment- Features of Private Payer and Cdhp
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HCR/230
Assignment: Features of Private Payer and CDHP
PPO:
Preferred provider organizations (PPOs) are the most popular type of private
plan, followed by health maintenance organizations (HMOs), especially the
point-of-service (POS) variety. In addition, Consumer-driven health plans (CDHP) that combine
a high-deductible health plan with a funding option of some type are rapidly
growing in popularity among both employers and employees Furthermore, few employees choose
indemnity plans because they would have to pay more. (Valerius, Bayes, Newby, & Seggern, 2008).
PPO stands for preferred provider organization and is a managed care organization of medical
doctors, hospitals, and other health care providers who have a binding agreement with an insurer or a
third-party administrator, which usually pay participating providers based on a discount from their
physician fee schedules, called discounted fee-for-service (Valerius et al, 2008). Providers in the PPO
will provide the insured members of the group a substantial discount below their regularly-charged
rates. This arrangement helps ensure that the insurer will be billed at a reduced rate when its insured
utilize the services of the preferred provider. Additionally, those who have PPOs have more flexibility
to choose a primary care doctor of their own choice, as well as being able to go to a specialist without
first having to get a referral from their primary care physician. PPO members also may be fully or
partially reimbursed if they use a doctor that is not listed in the PPO 'network.
HMO:
Health Maintenance Organization (HMO) is licensed by the state, which has lower costs, but the
HMO has the most strict guidelines and a limited choice of providers. Furthermore, members are
assigned to primary care physicians and must use network providers to be covered, except in
emergencies, which also uses an expanded network that...
HCR/230
Assignment: Features of Private Payer and CDHP
PPO:
Preferred provider organizations (PPOs) are the most popular type of private
plan, followed by health maintenance organizations (HMOs), especially the
point-of-service (POS) variety. In addition, Consumer-driven health plans (CDHP) that combine
a high-deductible health plan with a funding option of some type are rapidly
growing in popularity among both employers and employees Furthermore, few employees choose
indemnity plans because they would have to pay more. (Valerius, Bayes, Newby, & Seggern, 2008).
PPO stands for preferred provider organization and is a managed care organization of medical
doctors, hospitals, and other health care providers who have a binding agreement with an insurer or a
third-party administrator, which usually pay participating providers based on a discount from their
physician fee schedules, called discounted fee-for-service (Valerius et al, 2008). Providers in the PPO
will provide the insured members of the group a substantial discount below their regularly-charged
rates. This arrangement helps ensure that the insurer will be billed at a reduced rate when its insured
utilize the services of the preferred provider. Additionally, those who have PPOs have more flexibility
to choose a primary care doctor of their own choice, as well as being able to go to a specialist without
first having to get a referral from their primary care physician. PPO members also may be fully or
partially reimbursed if they use a doctor that is not listed in the PPO 'network.
HMO:
Health Maintenance Organization (HMO) is licensed by the state, which has lower costs, but the
HMO has the most strict guidelines and a limited choice of providers. Furthermore, members are
assigned to primary care physicians and must use network providers to be covered, except in
emergencies, which also uses an expanded network that...