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Managed Care coverage, which is more formally known as Health Maintenance Organization coverage, is a form of managed care insurance coverage. When you obtain this type of coverage, you will be able to acquire a number of different types of health benefits for a set fee. In other words, regardless of what the medical facility typically charges for a particular service, you will only be charged the amount that has been agreed upon with the insurance company.
In most cases, you are not expected to pay a deductible with this type of insurance coverage. Rather, you will be charged a co-payment each time you visit a doctor’s office. In most cases, these co-payments are only $10 to $25 per visit.
In order to receive the benefits that are provided from this type of insurance coverage, you will be required to select a primary care physician from a list of physicians that have been approved by the insurance company. This primary physician essentially becomes your “gatekeeper” to acquiring services from other physicians. This means that services provided by other physicians will not be covered by the insurance unless your primary physician has approved it first.
Since this form of insurance requires you to work through a primary care physician, you must contact the physician before seeing any other medical professional. After contacting your primary care physician, he or she will then refer you to a specialist if necessary. As with your primary physician, however, any specialists you are referred to must also be within the network of physicians that the insurance company has already established. If you go outside of your network, and it is not an emergency situation, you generally will not receive any coverage at all.
There are two basic forms of this insurance coverage that you might acquire. The first being the “Staff Model.” With the Staff Model form of coverage, the doctors are actually employees of the insurance company and you will be required to see them at a centrally located medical facility.
The other form is the Individual Practice Association, known as IPA. With this type of coverage, the insurance company actually contracts with individual doctors with their own private practices or with physician groups. As a result, this formation includes doctors within a variety of different locations rather than having all of the doctors located in one facility.
Depending upon where you live, the Staff Model might be preferable because all of the doctors are conveniently located in just one area. If this facility is located far from where you live, on the other hand, visiting doctors in this facility may be quite inconvenient. Therefore, it might be better to purchase a policy that follows the Individual Practice Association model so you can find a physician that is closer to you.
Although some people do not like this type of health insurance coverage because it restricts the doctors that can be utilized, it is one of the least expensive insurance options available. Not only do the premiums tend to be comparatively inexpensive, the amount of the co-payments is generally reasonable as well.
There are a number of different insurance companies that offer this type of insurance coverage. Therefore, it is in your best interest to compare the policies that they offer as well as the costs associated with each policy. That way, you can determine which company offers the policy that is best suited to your needs. In addition, you might want to consider the reputation of the company before doing business with it. That way, you can be certain to have the best experience possible with the company that you ultimately select.
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