4 ms·

You're correct. HMO = you have access to one provider PPO = you can't preferred access (lower patient costs) to one provider, but access to all

by refurb 3y ago

ggm 3y ago
> PPO = you can't preferred access (lower patient costs) to one provider, but access to all Can you fix the typo in this please? "can't preferred" -I want to understand what you're saying, I can't infer it yet.
- haldujai 3y ago
  I think the commenter means "you can have preferred access". PPO = Preferred Provider Organization. You have a better deductible/coinsurance/copayment for "in-network" (preferred) providers who have negotiated their rates with the insurer (or accepted the insurance company fee schedule). You typically need pre-authorization for elective surgery and advanced medical imaging. You have the option to see someone "out of network" but with less coverage. HMO = Health Maintenance Organization. Simple version is you don't get to choose your provider, you don't need preauthorizations and you have to go through your designated primary care provider to access specialists. For the most part you can only access providers within the HMO network if you want any coverage.
  - zamfi 3y ago
    > you don't need preauthorizations To be clear, in an HMO you don't need preauthorizations from your insurance but you still need your (not necessarily self-selected) PCP to order care or refer you to a specialist.
    - haldujai 3y ago
      Needing a referral (an assessment by a physician that something is medically appropriate) is not the same as needing preauthorization (insurance company agreeing to pay) but in any case hence the following "you have to go through your designated primary care provider". Many PPOs and public systems work in the same way, that's more about judicious and appropriate use of resources than payment authorization.
      - zamfi 3y ago
        Yes, I was just clarifying because PPOs often do allow you to seek out a specialist without a referral, and without requiring preauthorization.
- refurb 3y ago
  To late to edit, I blame my phone's autocorrect. It should read... You're correct. HMO = you have access to one provider PPO = you have preferred access (lower patient costs) to one provider, but access to all

You're correct. HMO = you have access to one provider PPO = you can't preferred access (lower patient costs) to one provider, but access to all

by refurb 3y ago

You're correct. HMO = you have access to one provider PPO = you can't preferred access (lower patient costs) to one provider, but access to all

ggm 3y ago

> PPO = you can't preferred access (lower patient costs) to one provider, but access to all Can you fix the typo in this please? "can't preferred" -I want to understand what you're saying, I can't infer it yet.

haldujai 3y ago
I think the commenter means "you can have preferred access". PPO = Preferred Provider Organization. You have a better deductible/coinsurance/copayment for "in-network" (preferred) providers who have negotiated their rates with the insurer (or accepted the insurance company fee schedule). You typically need pre-authorization for elective surgery and advanced medical imaging. You have the option to see someone "out of network" but with less coverage. HMO = Health Maintenance Organization. Simple version is you don't get to choose your provider, you don't need preauthorizations and you have to go through your designated primary care provider to access specialists. For the most part you can only access providers within the HMO network if you want any coverage.
- zamfi 3y ago
  > you don't need preauthorizations To be clear, in an HMO you don't need preauthorizations from your insurance but you still need your (not necessarily self-selected) PCP to order care or refer you to a specialist.
  - haldujai 3y ago
    Needing a referral (an assessment by a physician that something is medically appropriate) is not the same as needing preauthorization (insurance company agreeing to pay) but in any case hence the following "you have to go through your designated primary care provider". Many PPOs and public systems work in the same way, that's more about judicious and appropriate use of resources than payment authorization.
    - zamfi 3y ago
      Yes, I was just clarifying because PPOs often do allow you to seek out a specialist without a referral, and without requiring preauthorization.
refurb 3y ago
To late to edit, I blame my phone's autocorrect. It should read... You're correct. HMO = you have access to one provider PPO = you have preferred access (lower patient costs) to one provider, but access to all