Quote:
Originally Posted by 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.
HMO's, PPO's, "Networks" are very important to health insurance BEFORE one reaches age 65. There was not and is not any mention of them in Medicare other than to allow them in the supplemental insurance coverage.
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.
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Doc, you write your scripts and lance the boils. That is your honorable PROFESSION.
But please stop denigrating my PROFESSIONALISM as an insurance expert.
And I promise not to reduce any fractures or palpitate any livers.
I may check some breasts for lumps however, I'm not too old for that.