Question

An HMO plan that allows an enrollee to select a provider at the time of service is called a:

Group of answer choices

POS option

PPO product---wrong answer

MCO select

PSO choice

Answer 1

. POS

Health maintenance organizations (HMOs) of today aren't like the HMOs of the past. Some HMOs have a point of service (POS) option as well.

Most HMOs provide care through a network of doctors, hospitals and other medical professionals that you must use to be covered for your care. With an HMO-POS you can go outside of the network for care, but you'll pay more.

• You'll need to choose a primary care physician (PCP) to coordinate all your care.
• You typically don't need a referral to see a specialist, but your doctor can sometimes help you get in to see one more quickly.
• You'll need to work with your doctor to get prior authorization before you get some services. If you don't get prior authorization, some services may not be covered.
• The HMO and POS portions of the plan have separate deductibles. Care you receive in-network through the HMO has a different deductible than care you receive out-of-network through the POS. The two deductibles cannot be combined - they must be reached separately.

What's a Medicare PPO plan?

A preferred provider organization (PPO) plan gives you a financial incentive to select providers within the PPO network. That's because the health insurer has negotiated contracts with PPO network providers to provide health services at discounted costs. You can go outside of the network for care, but you'll pay more.

• You don't have to choose a PCP, although selecting one can help you coordinate care and help make sure your health care needs are taken care of.
• You don't need a referral to see a specialist, but you'll have to make your own appointments with specialists and other health care providers.
• You don't need prior authorization for services to be covered outside of the network.
• The amounts you pay toward your in-network deductible and your out-of-network deductible are combined. They don't have to be reached separately.

• Managed Care Organization

  A Managed Care Organization (MCO) is part of a Family Care Program that coordinates services from different existing programs and combines them into a single long-term plan of support and services based upon the needs and preferences of the members. MCOs improve the quality of services received by consumers.

• A patient safety organization (PSO) is a group, institution or association that improves medical care by reducing medical errors. In the 1990s, reports in several countries revealed a staggering number of patient injuries and deaths each year due to avoidable adverse health careevents.