Pros And Cons Of Private Payer Plans

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Private Payer Plans and CDHP Accounts Leslie Mechelle Wimberly Class: HCR/230 Claims Preparation II Footing the Bill Instructor: Sharlene Batts November 30, 2012 There are many insurance plans that are available to families today. In my paper we will go through a few along with some of their pros and cons. HMO means "Health Maintenance Organization." HMO plans offer a wide range of healthcare services through a network of providers who agree to supply services to members. With an HMO you'll likely have coverage for a broader range of preventive healthcare services than you would through another type of plan. As a member of an HMO, you'll be required to choose a primary care physician…show more content…
The PPO sponsor (employer or insurance company) generally reimburses the member for the cost of the treatment, less any co-payment percentage. In some cases, the physician may submit the bill directly to the insurance company for payment. The insurer then pays the covered amount directly to the healthcare provider, and the member pays his or her co-payment amount. The price for each type of service is negotiated in advance by the healthcare providers and the PPO. With a PPO you have a free choice of your health care provider. PPO members are not required to seek care from PPO physicians. There are also some disadvantages: Less coverage for treatment provided by non-PPO physicians. More paperwork and expenses than HMOs. As a PPO member, you may have to fill out paperwork in order to be reimbursed for your medical treatment. Additionally, most PPOs have larger co-payment amounts than HMOs, and you may be required to meet a…show more content…
The purpose of the eligibility period is to reduce insurance costs by preventing people from waiting until after they discover a health problem to sign up for coverage. Both employers and associations may also have an open enrollment period each year, during which you may sign, up for coverage, modify your existing coverage, or add dependents to your coverage. Some of the benefits for a group HMO is you don’t need a physical exam, under a group health insurance arrangement, the insurance company agrees to insure all members of the group, regardless of current physical condition or health history. The only condition is that the group members must apply for insurance within the specified eligibility period. It's cheaper than individual insurance because only one policy is issued for the entire group; the initial cost of establishing group coverage is lower than the cost of issuing a separate policy to each person. Also, group insurance is somewhat less risky for insurers than individual insurance, since the risk is spread out among a larger number of people. In many cases, your employer or association will pick up some or the entire group insurance premium. This can make group insurance even more affordable. There are also some draw backs of having group coverage. You can't customize your policy. In a group insurance, the

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