Thursday, January 27, 2011

Health Insurance?

I'm shopping for health insurance and am a bit confused by all the terms,Can someone tell me the difference between HMO's,PPO's,Network's,And Indemnity's and which is better?
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What slim said is accurate, I would just like to add/clarify. HMO - Uses a small network within your local area. Some require referrals and may services require authorizations. PPO - Use a large nation wide network. IE. If you have Pennsylvania Blue Shield PPO and you go to California, and the hospital participates with California Blue Shield PPO you are still in network (but with an HMO you would be out of network and with an HMO out of network is just not covered but with a PPO out of network is covered, it just process at a lower amount of payment than in network. Indemnity does not use a network but it is is very expensive and usually does not cover routine or preventive/screening services. Indemnity usually involves a lot of work for the member, you file most claims your self and with other plans, the provider will do it for you. Most have a deductible and alot do not cover regular office visits. This is old fashioned coverage and only covers services that are truly "Medically Necessary" (hence not covring routine). Usually, only inpatient services require authorization, and it is your responsiblity to take care of that. No referrals. I prefer PPO because it is portable across the country, and you do not have to worry about leaving your area. They usually cover routine/screening/preventive and many are deductilbe free if you stay in network. It covers office visits. Usually only inpatient services require authorization, but it is the participating providers responsibilty. No referalls. You do not have to file the claims your self, unless you go out of network.
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