Paul Wasser's profile

Comparing HMOs and PPOs

Following his tenure as the president and CEO of Dominican Village Independent & Assisted Living, Paul Wasser joined a healthcare consultancy firm which provided primarily acute care advisory services. The firm had asked Wasser to expand their organization into the sub-acute and long-term care arenas with regards to consultancy services. In this position, Paul Wasser did just that; offered all aspects of billing and insurance process advice to many multifaceted long term care organizations such as reviewing systems for managed care claims and payments. Here, knowing the primary comparisons between manage care and PPO's is of great significance.

Managed care is a type of health insurance plan in which insurers collaborate with specific health care networks and providers. Medical facilities within this health network are known as in-network providers. There are several types of managed care plans, with the most common being health maintenance organizations (HMOs) and preferred provider organizations (PPOs.)

HMOs connect policyholders to an in-network primary care provider. With an HMO, the primary care physician is responsible for screening patients before requesting the patient make an appointment with a specialist. These plans only cover medical care provided by in-network hospitals and providers. Patients must pay for out-of-network costs completely out of pocket.

Like HMOs, PPOs have preferred providers within their network. However, if a policyholder receives care from outside the network, a portion of the cost is still covered. Additionally, beneficiaries can see a specialist without going through their primary care provider. Due to this flexibility, PPOs tend to charge higher monthly premiums than HMOs.

Wasser provides stakeholders with the very best options through high end advice and direction.
Comparing HMOs and PPOs
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Comparing HMOs and PPOs

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