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Understanding PPO’s
Dr. David Edward Marcinko; MBA CMP™
Publisher-in-Chief
A preferred Provider Organization (PPO) is a bridge between traditional indemnity insurance and an HMO, and consists of several different types. It attempts to feature the provider choices seen in indemnity insurance, with the non-risk cost reductions seen in HMOs.
PPO Variations
Two similar entities, known as the Exclusive Provider Organization (EPO), and the Point of Service or Swing Out Plan (POS or SOP), consists of an exclusive provider panel who have agreed to accept a deep discount in their medical fees in return for the volume of patients the plans can provide to them.
Assessment
A combination of the above type models has been very successful for many employers, and this model is not as restricted by the HMO Act.
A payment time-line for a typical PPO may look something like the following:
Healthcare Provider bills PPO —> PPO bills company –> Company pays PPO —> PPO pays Provider
Conclusion
Which plan type above do you favor?
More info: http://www.springerpub.com/prod.aspx?prod_id=23759
Terms: www.HealthDictionarySeries.com
Speaker: If you need a moderator or a speaker for an upcoming event, Dr. David Edward Marcinko; MBA – Editor and Publisher-in-Chief – is available for speaking engagements. Contact him at: MarcinkoAdvisors@msn.com
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Filed under: Managed Care | Tagged: Health Care Finance |
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