[Anthony]

Dan, my understanding of a HMO is a health insurance plan that has no out of network benefits, that is, if I, as a medical provider, have not signed any agreement with that insurance company, then they will generally not pay for any services, either reimburse me or the patient. It is my understanding that an insurance plan that has out of network benefits will pay a provider or reimburse the enrollee for medical services either based upon the "true" charged amount, or the UCR rate even though that provider has never signed any agreement with the insurance comapny. PPO's generally have true out of network benefits, that will reimburse a provider/enrollee, as long as the provider I believe is licensed in that state to provide services.

If a provider is not signed up with either Medicare or Medicaid, no reimbursement will be made to either the provider or the enrollee. It's completely between the enrollee and the provider. I.E. No out of network benefits. HMO like. Medicare and Medicaid are both really like government run HMO's.