perfectionism and - Obsessive-Compulsive Foundation

6/14/13
HMO
HMO = Health Maintenance Organization
If you have an HMO, then the doctors and
hospitals are part of the same tight network.
Choosing your primary care physician will serve
as the “gatekeeper’ to your HMO.
Advantages:
Medical Records
Set Rates
Level of Care
Level of Benefits
Disadvantages:
Limited Geographical Availability
Having to Choose a Primary Care Provider
PPO
PPO = Preferred Provider Organization
If you have a PPO, then you have the option to
choose any provider within or outside of the
network.
Advantages
Choice
Availability
Disadvantages
Variation of out of pocket cost
Transferring medical records.
IN NETWORK PROVIDERS
Each provider PPO or HMO in your network has
agreed to accept your plan’s contracted rate as
payment in full.
The contracted rate includes both your insurer’s
share of the cost + your share.
OUT OF NETWORK PROVIDERS
HMO – Generally don’t provide Out-of-Network benefits.
PPO
• Higher deductible
• Co-pay
• Higher percentage of allowed amount
• Difference between allowed amount and providers actual
rate.
Reasonable/Allowed Amount: Determined by insurance.
$25
$75
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