Ah...The 'Crisis' Continues.......

[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.

[Dan40]

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.

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.

[Anthony]

Originally Posted by Dan40

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.

Dan, Dan, Dan.

I actually feel a little insulted if all you think a doctor does is to write scripts and lance boils. That maybe true for some docs, but not for me, and many other docs.

I guess your response is your way of saying you were wrong, and I was right.

[Dan40]

Originally Posted by Anthony

Dan, Dan, Dan.

I actually feel a little insulted if all you think a doctor does is to write scripts and lance boils. That maybe true for some docs, but not for me, and many other docs.

I guess your response is your way of saying you were wrong, and I was right.

No, that was my way of saying that you are so uninformed that I no longer wish to read any more of your ignorant ramblings. And if your medical knowledge equals your Medicare knowledge, writing scripts and lancing boils may be well over your head!

Those that wish to think you were right, are 100% free to follow your advice.
Those that think I am right are 100% free to follow my advice.
The next insult is completely yours as I have no interest in anything you have further to utter.