HMO… PPO… What sounds like alphabet soup is really the names for most common health plan types. Meet Sam. He wants to know how they work so he can pick the one that’s best for him. With an HMO, or a Health Maintenance Organization, Sam will have one main doctor called a primary care physician, or a PCP. Sam’s PCP will handle all of his care so when Sam is sick or needs, services he has to call the PCP first. Let’s say Sam gets an injury from playing soccer on the weekend. He wants to see a sports medicine doctor, but first he has to go to his primary doctor, his PCP. Sam’s doctor will help him decide the best way to treat his injury.
Sam’s doctor will send him to a sports medicine doctor in the list of HMO doctors, called a network, if that’s the right care. Doctors, specialists, and hospitals in the HMO network provide all the services. If Sam sees a doctor who isn’t part of the HMO network, he’ll have to pay the full cost of the services himself unless it’s emergency care. HMO plans come with setcopays for most services. The copay as what you pay when you use services, and you never have to fill out a claim form. What if Sam wants more options when choosing the doctors he sees? Then a PPO, or Preferred Provider Organization, could be the right fit. With a PPO, you can go to any doctor, whether or not the doctor is in the PPO network, without any referral from your main doctor. If Sam has a PPO plan when he gets the sports injury, he can go straight to any specialist he chooses.
He doesn’t have to see his main doctor first. Sam can see any doctor and specialist, whether or not they’re in the PPO network. He’ll pay less for the services he uses when he uses the PPO network. So to recap, the main differences between HMOs and PPOs: With an HMO, you have one main doctor who coordinates all of your care a set dollar amount to pay for doctor visits no claim forms to fill out A PPO offers: flexibility; the choice to go to any doctor no referrals lower out-of-pocket costs when using the PPO network. HMOs and PPOs are the most common types of health plans. There are other types too. Before you pick your plan, take a look at how it works. That way you can make sure your coverage fits your preferences. Also, not every health care coverage company offers every kind of plan in every geographic area. To learn which plans are available where you live in Cal Thanks for watching!. Here is your link to Health Net Health Net
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