What is the difference between HMO and PPO?
Health maintenance organization (HMO) and organizations of preferred providers (PPOs) have several differences, such as which doctors can see, how much services cost and how medical records are kept. The most important difference between the two organizations is the possibility to select a health care provider. As the name suggests, the preferred organization of providers allows the patient to select any healthcare provider, inside or outside the network, while the health maintenance organization usually requires the patient to select a primary care provider that can provide recommendations to other medical specialists.
Selection of healthcare provider
PPO offers selection and flexibility, but is often more expensive. With PPOs, patients can see any doctor they want, or visit any hospital they choose, usually within the preferred network of providers. One does not need to mark primary care doctors and can usually see any specialist without recommended.
On the contrary, HMO requires patients to see only doctors or hospitals on their providers' list, and patients have to choose primary care doctors to direct care and recommend patients with approved experts. This type of organization offers fewer options and can be difficult to change doctors or look for second opinions. Generally, HMO will not cover therapeutic expenses incurred by seeing someone who is not closed with the HMO, but will usually have a defined coverage of emergency medical care when patients travel outside the normal coverage area.
There are a few exceptions: a large HMO, such as Kaiser Permanente, can allow patients to use hospitals or specialists providing a service that their contractual physicians and facilities do not provide. If the health situation is not an emergency situation, acquiring such services usually includes approval processes and May requestThey give a large amount of paperwork and bureaucracy.
differences in cost
Depending on the conditions of PPO coverage, a doctor or hospital outside the list of preferred providers will cost more than in the network; The organization will usually pay a range of 70 to 80 percent of accumulated expenditure, while the patient pays the remaining balance outside the pocket. HMOs generally have the costs of each service, which facilitates planning the cost of treatment. The organization will often be paid a specified percentage of the bill and the patient is obliged to pay the remaining balance by its own money as soon as the specific deductible is met.
medical records
When a patient chooses a primary care provider with HMO, medical records are held together in the organization. In accordance with another provider, any related medical records are usually automatically transmitted to a new device. While the preferred organization provider allows patients to selectT provider in or outside the network, does not store medical records in one place, which may mean that the patient can spend more time attempting to transfer medical records.
Selection of an organization
Employees often have no choice what insurance they can get because their company will offer only one or the other. When choosing, they can usually choose between health maintenance and preferred organizations. Depending on the patient's health and income, PPOs may eventually be a better choice because it provides access to a larger number of providers and healthcare facilities. It is wise to determine the number of network doctors and equipment offered in the PPO plans before the decision, as some HMO plans can be better offers when HMO closes with more providers than PPO.