Since you will be working in a medical setting seeing patients, it is important to know how the payment system works. Employers and private insurance companies offer a variety of benefit plans and it can become confusing. Let’s begin with the basics. The sources of payment for health care services consist of the following:
- Self-pay (no health insurance and the patient pays out-of-pocket)
- Government (Medicaid, Medicare, and other government programs)
- Private insurance health care plans
There are six different types of private insurance health care plans.
- Indemnity plan – Often called fee-for-service that allows you to go to any doctor and the insurance company pays 80 percent and you pay 20 percent. This is the most expensive plan available.
- Health Maintenance Organization (HMO) – Most restrictive of plans and physicians are employed by the HMO. You must see an HMO primary care physician prior to seeing a specialist. Preventative care is stressed.
- Preferred Provider Organization (PPO) – You will have a list of PPO providers that are in the network but they are not employed by PPO. You do not have to seek permission to see a specialist.
- Point-of-Service (POS) Plan – You select which doctors you want utilize (in-network or out-of-network) and pay co-pays accordingly. This plan provides you flexibility and contains some of the HMO and PPO features.
- Exclusive Provider Organization (EPO) – This plan operates like an HMO but the providers are not employed by the EPO. Often an EPO may be insured or self-funded by an employer.
- High Deductible Health Plans (HDHP) – You pay the full cost of most office visits until you meet the high deductible. Premiums are lower and the HDHP is often coupled with a Health Savings Account (HSA).
This is an introduction to the rudimentary elements of private insurance health care plans.