Essay On Managed Care Organization

Certainly, the contribution of the Managed Care Organization to the present health system of the United States cannot be overstated; hence, the managed care organization is considered an integral part of the complex health care system in the United States. Through the evolution of the managed care industry, the organization has created various modalities of delivering health care services to their respective beneficiaries. For example the PPO, a PPO by all indications is a group of health service providers, such as hospitals and doctors, which agrees to provide services to an insurer’s customers at certain set rates. As a purchaser of health insurance, the most appealing health insurance model to me is the preferred Provider Organization (PPO). The PPO health plan has contracts with a network of preferred providers from which patients or beneficiaries can choose. Providers outside the PPOs’ network are covered but at a much higher cost to the health care beneficiaries. For example, a patient might have a 20 % copay to see an in-network physician, but a 50 percent coinsurance charge for seeing an out-of-network physician. Hence, if the out-of-network physician charges $250 for that office visit, the patient will pay $125instead of the $50 copay the patient would have been charged if he or she had used an in-network physician. …show more content…
Most individual in the United States will purchase the insurance plan that fit their lifestyle or their budget or both. I for one I choose to purchase the PPO plan offered by the institution I work for because of the flexibility of the plan. Regardless of the insurance of choice, it is imperative that beneficiaries understand the plan they wish to purchase as could make a difference between financial stress or financial wellbeing health plan