Question

Examine your (or someone you know) insurance card for health benefits. Describe the type of plan (HMO,PPO, etc), amounts and types of co-pays for services, whether or not you need/have a primary care physician (PCP). Do you feel you have adequate coverage under your plan? Why or why not?

Answer 1

Types of plan

HMO

HMO type of plan primary care physician is needed, and the patient has to visit the primary care physican first to get referral. After getting referrals only the patient can vist specialist like cardiology, neurology etc

In HMO the patient do not have to claim for any returns, patient will not receive any bills

Patient has to visit the hospitals only within HMO, otherwise they will not get their insurance

PPO

PPO plan there is no primary care physician

Patients will get the benefits of insurance even if they visit any other hospital out of the PPO network

But in PPO for hospitals outside its network, patient has to pay the bill first and then claim for return. The bill will only consider the bill, other payments like doctors fee etc is not taken into consideration.

No I don't feel I have an adequate coverage, because most often OPD services are used, and they are not covered in any insurance.