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Health Management Organization Ppo

Essay by   •  September 7, 2011  •  Study Guide  •  588 Words (3 Pages)  •  1,953 Views

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Health care systems are a group of individuals, organizations, and resources that supply health care services to provide health care needs of targeted persons. The two broadly recognized healthcare establishments that provide insurance are, Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO).

HMO is an abbreviation for Health Management Organization. HMOs are regularly considered to be much less expensive to the extent of premium payments compared to traditional PPOs. HMO is essentially designed in order to regulate healthcare's cost. HMOs are considered to be inexpensive due to fees per visit being so little or none at all. In the introduction of HMO, member's monthly premium was fixed, prepaid in interchange for health care insurance from a contracted network of providers. Hospitals, clinics and health care providers that have signed a contract with the HMO make up this contracted network of providers.

HMOs restrict the procedures; providers and benefits much makes this plan the most limiting method of achieved care plans. This fact is due to members being required to use these providers and no others. Together with the detail of HMOs being low-priced, HMOs are recognized for not allowing their members any choice. HMO members have their doctors selected for them. HMOs focus primarily on precautionary care, in which providing physicals and additional services directed toward preserving health at no charge to policyholders. HMOs have become limited in the network of physicians that are available to members. This is due to HMO authorized physicians having full practices and having to close their practices to new patients.

Obtaining approvals for medical care by specialists may be considered a hassle for some. HMOs commonly refuse to permit payments for a referral that the primary physician considers as needed. Most HMOs function by disbursing payment to member physicians on a per-patient base, with some systems correcting physicians who have patients that use an excessive amount of high-cost procedures. Alternatively, managerial costs and other expenses for HMOs are greater than for other types of insurance plans.

The PPO is most often the preferred choice this is because PPO plans gives members the flexibility in generating personalized plans in contrasted with the more restricted HMO plans. PPO is different from an HMO due to it providing the insured member the ability to receive service and treatment from providers outside the network of physicians and facilities. Innumerable details exist that may persuade or cause a member to prefer services from a doctor or facility that is not contracted with the health insurance carrier.

A Preferred Provider Organization, or PPO, is a managed care health insurance plan that operates a network of physicians and facilities contracted by the insurance carrier to provide services within discussed price boundaries. At the time of

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