Features_of_Health

Features of Health Plans 2 In health plans, there may be variations however all insurance plans are one of the two essential types, which are indemnity or managed care. The five health plans mentioned in the chapter are Indemnity Plans, Health Maintenance Plans (HMO’s), Point of Service (POS), Preferred provider organization (PPO), and Consumer- Driven Health Plans (CDHP) (Introduction to the Medical Billing Process, 2008). There are important differences as well as similarities regarding all health care plans. One similarity is that all healthcare plans have an arrangement that is between the insurer and health care providers such as doctors and hospitals. Normally, there are specific standards for selecting providers and formal steps to ensure that quality care is delivered. Under the Indemnity Plans, the payer indemnifies the policy holder against medical service and procedure costs (Introduction to the Medical Billing Process, 2008). The physician bills the insurance company as services are given. Patients also choose their own providers. Health Maintenance Organizations have premiums, which are prepaid and a combination of coverage of medical costs and delivery of healthcare is provided (Introduction to the Medical Billing Process, 2008). The network that is created contains physicians, hospitals, and other providers. Membership enrollment is required along with preventative care and referrals are often needed for specialty services (Introduction to the medical Billing Process, 2008). Point of Service Plans are similar to the HMO plan, which is specifically called an open HMO, which reduces restrictions and allows members to choose providers who are not in the HMO’s network. Members also have to pay additional fees that are set by the plan when they use out-of-network providers (Introduction to the Medical Billing Process, 2008). Preferred provider Organization manages care, but is the Features of Health Plans 3 most preferred and most popular type of plan. There is a network of physicians, hospitals as well as other providers with whom they have negotiated discounts from usual fees (Introduction to the Medical Billing Process, 2008). Consumer-Driven Health Plans have two elements, which are combined in its plan. One is a health plan which is normally a PPO, which this plan has a higher deductible and lower premium (Introduction to the Medical Billing Process, 2008). Second, is the special savings account, which is used to pay medical bills before deductible is met. In my opinion, I think that the HMO’s provide greater benefits to providers because patients are limited to in-network providers. Fixed premiums have to be paid by patients for coverage and these patients can only use the network’s hospitals and doctors. The PPO’s appear to be more beneficial for patients because they go to any hospital or see any doctor that they choose. Along with this, they can also save money by going to a doctor or hospital that the PPO plan approves.