UNDERSTANDING INSURANCE - AMERICAN PPOs & HMOs

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This page contains dozens of short articles that will help you quickly understand international insurance. For example, terminology, purchasing details and managing your insurance coverage are topics that are all covered within these articles. Choose an Article From the Topics Below

AMERICAN PPOs & HMOs - WHAT'S THE DIFFERENCE?

In an HMO (Health Management Organization) you must choose a PCP (Primary Care Physician). This physician will be your "Care Manager" in the health care system. Your PCP, if he finds it necessary, will generally refer you to a specialist working within the HMO. He directs all of your medical care, making sure you don't receive unnecessary services. Sometimes the PCP is referred to as the "Gate Keeper" because he opens the gate and directs you to other providers within your HMO system.

A PPO (Preferred Provider Organization) is a network of medical and health care providers who agree to provide services for a specific amount and adhere to medical utilization guidelines. In a PPO you do not have a Primary Care Physician (although you may choose to have a physician function in that way). Instead you are given a list of physicians that work within a network. You can choose any physician you like and a different physician every time you have a medical need as long as you choose them from the list of doctors provided by the PPO, that is, as long as the physician is in the PPO network. Some PPOs have thousands of physicians in their network.

Some people feel HMOs are better than PPOs because they generally hold down the cost of premiums. They do this because the physician controls the extent of the care given. Others feel PPOs are better because the patient has more freedom and say in the choice of physicians and treatment.