PPO vs HMO

I was asked the other day what PPO & HMO mean...here's what the acronyms stand for...

PPO: Preferred Provider Organization

HMO: Health Maintenance Organization

What does this mean to you? Often times if you're on an HMO plan you need to "declare" a PCP with your insurance carrier and must have referrals to see a specialist.  If you have a PPO plan you likely don't need to have referrals to see specialists.  In either case you want to be certain that the doctor's you see are in network with your PPO or HMO plan. 

Another question was why doesn't our health care system work more like building contractors?  In other words why can't the hospital take one payment from the insurance carrier and patient and then divide it accordingly to the hospital, surgeon, and anesthesiologist when a patient has surgery?  I was intrigued by this question and plan to do some research into it.  I have a sneaky suspicion that there are some federal and state regulations out there that would keep something like this from working, but with a major overhaul to our health care system it could have potential. 

What are your thoughts?

deargabbyinsurance@yahoo.com

The New Year a New Card

Tis the season for remembering to bring your new insurance card to your next doctor's appointment.  Not doing so can be disastrous.  It's a huge waste of time an money for an office to file with the wrong insurance carrier or with incorrect insurance identification numbers.  January 1 usually marks the time that any updates to your insurance policy take effect and new cards get mailed out to patients.  Even if you think nothing has changed with your ID number it doesn't mean your benefits didn't change.  Copays, Coinsurance, and deductibles often vary from year to year with policies that are carried through an employer.  If you're not sure your policy changed or if you haven't gotten your new cards in the mail this week (first week of January), call your HR department or your insurance carrier and ask.


An interesting article on Medicare and how we pay into the system...

http://m.apnews.com/ap/db_16026/contentdetail.htm?contentguid=Ag8SIFWG

Questions? Comments? Complaints?
deargabbyinsurance@yahoo.com