Managed care plans use networks of doctors, hospitals and other providers selected to provide comprehensive health services to plan members. In a health care plan administered generally you would have less paperwork and expenses out of pocket would be lower, but usually will be restricted in their choice to choose their doctors. In Texas there are two types of schemes managed health care, preferred provider organizations (PPO, for its acronym in English) and maintenance organizations (HMO, by its initials in English).
Insurance companies issuing PPOs. You can take your child to any doctor or provider you choose, even if the physician or provider is not in the PPO network, but the expense of his own pocket would be less if you use the network providers. PPOs typically require you to pay a monthly premium, coinsurance and copayment each time you receive medical care.
HMOs usually require that you only use doctors, hospitals and other health care providers within its network. You have to choose a doctor to oversee health services your child and acts as the “guardian” to see other providers. This means that you must get a referral from your doctor if you take your child to a specialist or other doctor.
Generally, the HMO does not pay for services received outside the network, except in cases of medical emergency or other certain circumstances. Therefore, if your child receives medical emergency is not a provider outside the HMO network, most likely you will be responsible for paying the entire account.
HMOs typically require you to pay a monthly premium and a copayment each time you go to a doctor or medical attention.
Tags: Health Insurance Plan, health insurance requirement, health service, hmos requirement, insurance company, managed care insurance
