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Health and Medical Insurance Differences: HMO, PPO, POS, EPO

MULTIZ321

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Health and Medical Insurance Differences: HMO, PPO, POS, EPO
By Mila Araujo/ Insurance/ Health Insurance/ The Balance/ thebalance.com

"Understanding Managed Health Care Plans

HMO, PPO, POS, and EPO - What Are the Differences?

With so many letters to keep track of, it is no wonder the differences are between HMO, PPO, POS and EPO health care plans are confusing. HMO, PPO, POS and EPO's are managed healthcare plans.

Different Types of Managed Healthcare Plans: HMO, PPO, POS, EPO Explained


Managed health care plans are an alternative to traditional health care plans like fee-for-service plans. In the past few decades, managed health care plans have become a popular health insurance choice as health care costs have increased. The type of managed plan you have will dictate how you obtain your medical services so it is worthwhile learning about them and how they work.




    • Health Maintenance Organization (HMO)
    • Preferred Provider Organization (PPO)
    • Point of Service Plan (POS)
    • Exclusive Provider Organization (EPO)
A really easy way to understand the main differences in these is how restrictive or flexible the networks they use are. The health insurance network is who you are allowed to get medical services from in order to get paid on a medical claim.


With changes in medical care and healthcare, plan sponsors look to find ways to reduce costs for themselves and plan members, the tighter the network of providers, the more cost efficient the plan.


This is why there are different options, your choice of health insurance plan type will make a difference in the cost and being familiar with the options may help you find affordable health insurance.


We are going to review everything about managed care for you, as well as outline the key points for each of the HMO, PPO, POS and EPO health insurance plans so you can understand the differences and how the different managed care plans work....."


Richard

 

WinniWoman

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i hate the whole convoluted health insurance system!

We have a high deductible plan. I have never reached my annual out of pocket and assumed this year would be no different. I have been having PT visits starting in December and paying $15 per visit. Well- the New Year rolled around and suddenly I see on the Aetna website that the visits are now going to cost me $79 per visit out of pocket!

Upon further investigation I see the insurance company claimed I met my out of pocket in December, hence they paid more towards each of the PT visits.

Only thing is- I pointed out to them- I DID NOT meet my out of pocket for the year! Somehow they mistakenly put a drug I never bought (another long story) towards my deductible! So essentially I was supposed to be paying $79 all along! For a 1/2 hour visit where they put me on an exercise bike for 10 minutes and then massage my leg with a metal tool and send me home. For this i have to use gas and drive a half hour there and back. Not worth $79!

Ummm- before I even went there I would do one hour of exercise- including 25 minutes on my indoor cycle! And some exercises for my calf that they showed me- which I could have probably found on the internet.

So I have now cancelled all the visits I had scheduled and now use the back of a big colonial style, silver plated knife and coconut oil to do my own leg massage.

SMH............
 

Tia

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Get ready to pay for those PT visits, now they realize there was a mistake

It's a racket, for profit imho
 

Steve Fatula

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i hate the whole convoluted health insurance system!

We have a high deductible plan. I have never reached my annual out of pocket and assumed this year would be no different. I have been having PT visits starting in December and paying $15 per visit. Well- the New Year rolled around and suddenly I see on the Aetna website that the visits are now going to cost me $79 per visit out of pocket!

Upon further investigation I see the insurance company claimed I met my out of pocket in December, hence they paid more towards each of the PT visits.

Only thing is- I pointed out to them- I DID NOT meet my out of pocket for the year! Somehow they mistakenly put a drug I never bought (another long story) towards my deductible! So essentially I was supposed to be paying $79 all along! For a 1/2 hour visit where they put me on an exercise bike for 10 minutes and then massage my leg with a metal tool and send me home. For this i have to use gas and drive a half hour there and back. Not worth $79!

Ummm- before I even went there I would do one hour of exercise- including 25 minutes on my indoor cycle! And some exercises for my calf that they showed me- which I could have probably found on the internet.

So I have now cancelled all the visits I had scheduled and now use the back of a big colonial style, silver plated knife and coconut oil to do my own leg massage.

SMH............


Just make sure you really do do the work. PT can be like timeshares, i.e. many say I own a timeshare as it forces me to take vacation. PT forces you to do (at least some) of the work and corrects often for doing it the wrong way. I am very happy I did the enormously painful shoulder PT after surgery (well, months after) as I for the first time in 48 weeks of recovery, I now shot basketballs this past week. I really thought that was going to be super painful or that I simply wouldn't even be able to move my shoulder that way, but, it was ok actually and I even started making free throws, though I could barely shoot that far sadly. Still, it was nice to see some strength coming back.

My cash price for my 1 hour PT sessions here was $50, less than your insured price. I too hate the health insurance situation as it is today (or even years ago for that matter). My latest hassle now is my surgery from February. They collected a deductible (the hospital) from me when I went in for the surgery, told them I had already met mine but they insisted. Bad move for me. So, now that everything is settled, they won't give me my $500 back. The insurance EOB clearly says no deductible, yet, they won't give it back. Might go to small claims court. That would be interesting as have never been in court.

Still doing well on my health sharing arrangement. Paid for my surgery in full.
 
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WinniWoman

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Just make sure you really do do the work. PT can be like timeshares, i.e. many say I own a timeshare as it forces me to take vacation. PT forces you to do (at least some) of the work and corrects often for doing it the wrong way. I am very happy I did the enormously painful shoulder PT after surgery (well, months after) as I for the first time in 48 weeks of recovery, I now shot basketballs this past week. I really thought that was going to be super painful or that I simply wouldn't even be able to move my shoulder that way, but, it was ok actually and I even started making free throws, though I could barely shoot that far sadly. Still, it was nice to see some strength coming back.

My cash price for my 1 hour PT sessions here was $50, less than your insured price. I too hate the health insurance situation as it is today (or even years ago for that matter). My latest hassle now is my surgery from February. They collected a deductible (the hospital) from me when I went in for the surgery, told them I had already met mine but they insisted. Bad move for me. So, now that everything is settled, they won't give me my $500 back. The insurance EOB clearly says no deductible, yet, they won't give it back. Might go to small claims court. That would be interesting as have never been in court.

Still doing well on my health sharing arrangement. Paid for my surgery in full.

That's great you are doing well. Not so great about your $500. I would not let them get away with it. I do not see how they can keep the money. I would think it is illegal.

I notice every time you go to an doctors office they are telling you from the get go how much you owe. Or you have a deductible. Oh- really? Well I was at another doctors yesterday and they said the same thing. How do you know I didn't pay them the deductible? I mean- come on! Uh- yeah- I know what I owe and make sure you send me a bill 'cause I am not paying it until I see my insurance EOB. It's really getting bad. I always pay my bills and I resent being talked to like I am some sort of imbecile.

As for me- yes I do the work. I have the discipline to exercise every day and I just tack the extra time on to that.
Like I said- I already use my indoor cycle. And there is nothing to rubbing a piece of metal up and down the back of my leg. Just that I can't lie down doing it, obviously. I only had 3 more sessions left and then an evaluation- at least according to the original doctor's orders.
 
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