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PPO - generally has a larger list of MD's and allows you to see MD's outside of the network, but at a lower payment level.
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∙ 15y ago
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Can a fl humana hmo doctor force a patient to use a particular lab or mri faciliity?
No. But the HMO will.
Why HMO were formed in the first place?
HMO's were formed because, HMO reflected not consumers' demanding coverage or non-physician entrepreneurs seeking to establish a business but rather providers wanting to protect and enhance patient revenues.
where can I get hmo insurance plan ?
If you are employed you can get your HMO through your employer. You can also get an HMO if you are not employed, however it will cost you more since an HMO is a shared cost among many people in the company.
Can an employer use the services of an HMO clinic for 5 or more employees?
That depends on the contracts available from the HMO. Most HMO's have a variety of services available with different price ranges depending on the number of employees to be covered. I've had HMO's at companies with far more than 5 employees.
If you switch from HMO back to Medicare can the skilled nursing facility that the patient is at bill Medicare for skilled needs?
If they are under skilled HMO yes you can bill Medicare. You still have to follow the assessments needed by Medicare
What are the differences between PPO health insurance and HMO?
PPO stands for Primary Provider Organization, which means you can see phycians "in or out of network". Out of network will always be more money out of pocket to the insured. HMO stands for Health Maintanance Organization. HMO's do not have "out of network" benefits. HMO's are much more restricting because you are limited to the physicians and facilities that may be used.
What is the most popular medical replacement HMO?
The most popular medical replacement HMO is knee replacement. You can read more at www.nursinghumor.com/medical/hmo.physician.recruitment.prequalification.form.htm -
Who is the person within an HMO who has been assigned to monitor the services provided to the patient both inside the facility and outside the facility?
gate keeper
What kind of services are provided by the Aetna HMO?
Aetna HMO provides insurance services. Some examples of insurance services available through Aetna HMO include Dental, Health and Medical insurance. You can learn more at the Aetna website.
Can a noncontracted hmo provider bill a patient?
AnswerYes. "Non-contracted" means there is no contract with the insurance company to prevent the doctor from billing whatever he likes.
Is a HMO insurance coverage usually more expensive than a PPO?
For the most part, no. An HMO is a type of managed care plan that focuses upon keeping the member healthy. It is a genre of "managed care", of which there are several models. The models differ mostly in the amount of choice that the member is given in using physicians of his/her choice, at least without first getting a referral from the member's "primary care physician". The primary care physician is a provider under the HMO and assumes the main responsibility for the patient's care, and, as necessary, referrals to specialists. Because the HMO "manages" the care, the care is kept in a fairly tight sphere, thereby lowering overall costs. Therefore, participation by a member in an HMO is usually amoing the more economical health care options. Although HMOs are not technically "insurance", they are generally regulated by state insurance regulators. The insurance regulator is concerned with the HMO's financial stability, reasonableness and sufficiency of rates, and similar factors/
Can you have a hmo and a ppo plan at the same time more specifically kaiser hmo through my employer and aetna ppo through my spouse's?
Technically yes, each of you will have your own primary plan and all claims for each will go through that plan first, but as secondary, the other plan will cover in areas where the hmo does not with provisions, each plan is different that way, but usually it gives more options for health care where to hmo is restrictive, you just have a lot more hoops to jump through.
