In every type of HMO, every employer pays the same monthly premium for HMO service. Each employee is assigned to a primary care doctor for when they need medical attention. If the employee has a problem that is out of the physician’s area of expertise then that person is referred to another HMO physician. In the event the employee needs immediate medical attention or medicine, they are referred to hospitals and pharmacist within their HMO. There are various types of HMOs but first lets address group-model HMO. In group model HMOs the health benefit intermediary contracts with a multispecialty group practice to provide medical care to the HMO’s members. The doctors in the group practice are employed by the group practice and not …show more content…
The PPO is a network of physicians, hospitals, dentists, labs and home health care that contract with the company offering the health care plan. All the providers agree to a rate under the PPO scheme. The PPO gives patients more flexibility in choosing a doctor and health care providers. Other benefits under the PPO plan are: patients do not need referrals to see specialist, members of PPO plans get faster treatment than those under HMO plans, and they can choose providers outside of the PPO network. PPO copayments are 10% of charges for care in network and 30-40 % of care charges out of network. Patients are reimbursed for the rest of the network