ALCapshaw2
Well-known member
Don't forget that access to your Doctor of Choice is also highly dependent on what type of Insurance one carries.
Health Maintenance Organizations (HMO's) are set up where your Primary Care Physician (PCP) acts as a "Gatekeeper" to screen patients. HE determines IF and WHEN he will Refer patients to a specialist (IN-Network). (NO THANK YOU!)
PPO's (Preferred Provider Organizations) have a list of Participating Preferred Providers that patients can see. Most have a PCP but his referal is NOT necessary for patients to see a specialist (within the PPO Network).
Networks can be Local or Statewide. Some also include Major Out-of-State Hospitals (such as Mayo Clinic, or Cleveland Clinic, or Big Hospitals in Nearby States as 'in-network providers. Out of Network Providers can also be used with higher co-pays or by referal for complex cases. Such systems usually work well for most patients while helping to minimize costs.
I don't know a lot about Independent / Private Insurance.
(Many / Some) Employers offer employees their choice of HMO, PPO, or Private Insurance at varying (shared) costs with the employee. Such systems are becoming harder to find (not to mention more expensive) for New Employees.
For patients 65 years old and over, Medicare (Government Provided) and Private Medicare Supplemental Policies allow patients to see ANY Doctor, ANYwhere, for ANY reason, Without Referal. Some of the Private Policies are a bit 'pricey'. It pays to 'shop around' to compare costs.
The government has mandated/defined 12 different Plan Levels (A-L) which are identical from all Insurers. Costs vary by the Claim Experience of each provider in your state.
Stand-Alone Prescription Drug Plans are now also available with widely varying costs and co-pays. My state has 49 different plans licensed to sell here. Medicare (and Walgreens) have computer programs that calculate your expected annual costs for each program. There is an "Open Enrollment" every year from Nov 15 thru Dec 31 and subscribers are wise to compare plans EVERY year because costs and coverage can change. (Anybody have an aspirin?)
So called "Advantage Plans" require a PCP (Gatekeeper) and the use of In-Network Providers and carry Co-Pays for each visit. These plans save money for patients who don't need to see Doctors very often. (NO THANK YOU - I want to be able to see WHO I want, WHERE I want, WHEN I want, Without Referal.) Many Advantage Plans include Prescription Drug Coverage. Again, it pays to 'shop around'.
'AL Capshaw'
Health Maintenance Organizations (HMO's) are set up where your Primary Care Physician (PCP) acts as a "Gatekeeper" to screen patients. HE determines IF and WHEN he will Refer patients to a specialist (IN-Network). (NO THANK YOU!)
PPO's (Preferred Provider Organizations) have a list of Participating Preferred Providers that patients can see. Most have a PCP but his referal is NOT necessary for patients to see a specialist (within the PPO Network).
Networks can be Local or Statewide. Some also include Major Out-of-State Hospitals (such as Mayo Clinic, or Cleveland Clinic, or Big Hospitals in Nearby States as 'in-network providers. Out of Network Providers can also be used with higher co-pays or by referal for complex cases. Such systems usually work well for most patients while helping to minimize costs.
I don't know a lot about Independent / Private Insurance.
(Many / Some) Employers offer employees their choice of HMO, PPO, or Private Insurance at varying (shared) costs with the employee. Such systems are becoming harder to find (not to mention more expensive) for New Employees.
For patients 65 years old and over, Medicare (Government Provided) and Private Medicare Supplemental Policies allow patients to see ANY Doctor, ANYwhere, for ANY reason, Without Referal. Some of the Private Policies are a bit 'pricey'. It pays to 'shop around' to compare costs.
The government has mandated/defined 12 different Plan Levels (A-L) which are identical from all Insurers. Costs vary by the Claim Experience of each provider in your state.
Stand-Alone Prescription Drug Plans are now also available with widely varying costs and co-pays. My state has 49 different plans licensed to sell here. Medicare (and Walgreens) have computer programs that calculate your expected annual costs for each program. There is an "Open Enrollment" every year from Nov 15 thru Dec 31 and subscribers are wise to compare plans EVERY year because costs and coverage can change. (Anybody have an aspirin?)
So called "Advantage Plans" require a PCP (Gatekeeper) and the use of In-Network Providers and carry Co-Pays for each visit. These plans save money for patients who don't need to see Doctors very often. (NO THANK YOU - I want to be able to see WHO I want, WHERE I want, WHEN I want, Without Referal.) Many Advantage Plans include Prescription Drug Coverage. Again, it pays to 'shop around'.
'AL Capshaw'
