Hcr 230 Features of Private Payer and Consumer Driven Health Plans

Topics: Health insurance, Health maintenance organization, Preferred provider organization Pages: 2 (684 words) Published: July 10, 2014
A HMO is accredited by the state. For its more abject costs, the HMO has the most rigorous guidelines and the minutest alternative of suppliers. Its extremities are allotted to principal care doctors and must utilize network suppliers to be addressed, omit within exigencies. HMO were primitively planned to address all canonical services for a yearly bounty and visit co-pays. A health maintenance organization is coordinated throughout a business model. The model is based on how the terms of the correspondence link the supplier and the plan. Within all, nevertheless, enrollers must see health maintenance organization suppliers within order to be addressed. A group HMO foreshortens with more than one doctor group. Within some plans, health maintenance organizations members receive medical services within health maintenance organization owned facilities from suppliers who cultivate only for that HMO. Within others, members inflict the supplier’s facilities, and the suppliers can also treat nonmember patients. IPA (Independent or Individual Practice Association) type of health maintenance organization is an affiliation made by doctors with individually owned practices who foreshorten united to supply care for HMO members. A health maintenance organization compensates managed fees for medical services to the Independent Practice Association. The IPA in turn compensates its doctor members, either through a fee or capitates rate. Suppliers may link more than one IPA and generally see nonmember patients. A point-of-service plan is intercrossed of PPO and HMO networks. Members may prefer from a primary or secondary network. The primary network is HMO-like and the secondary network is generally a PPO network. Like HMOs, POS plans appoint a yearly premium and co-pay for office inflicts. A point-of –service may be integrated as a tiered plan, for exemplar, with dissimilar rates for particularly assigned suppliers, veritable participating suppliers, and out-of-network...

References: Valerius, J., Bayes, N., Newby, C., & Seggern, J. (2008).Medical insurance: An integrated claims process approach (3rd ed.). Boston: McGraw-Hill.
U.S. Treasurer’s Office. http://www.treasury.gov.resource-center/faqs/Taxes/Pages/Health-Savings-Accounts.aspx
The Regence BlueCross BlueShield of Oregon. http://www.regence.com/
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