The Pros And Cons Of Managed Care

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Managed care is the most prevalent form of health insurance plan that has significantly changed the ways that patients receive care and allowing them a variety of affordable care. Under managed care, health insurance plans have a contract with providers and hospitals to provide care for clients at lower cost. Clients who choose to enroll in a managed care plan should also be aware of both the benefits and the drawbacks of those care plans.

Criticism/drawbacks

Managed care health insurance plans, mostly the HMO 's, focus primarily on prevention, and people with these types of policies pay less for their coverage. The newest options in health insurance plans include the PPO (preferred provider organization) plans. Due to their flexibility, these plans are
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Patients may feel like they are locked to a specific health care provider that they may not feel comfortable or not familiar with their practice. Managed Care Organizations (MCO) has direct contracts with health care providers while these providers form a MCO service network (Lu & Fei, …show more content…
PPO plans are allowed to go to outside network agencies to receive medical care, but the difference is that an out of pocket expense is required for this specific service. When visiting a physician for a regular office visit or other services, there is a small co-payment that will be required. If the patient decides to go outside the network, then they may be required to pay for medical services upfront, and would have to submit the receipt to the PPO insurance company to get reimbursement for some portion of the expenses (California Health Plans, n.d.). Lastly, the patient will need to choose a primary care provider, but will not need a referral to see a

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