Private Health Insurance: A Sense of Dissatisfaction
Private Health Insurance: A Sense of Dissatisfaction Exploring the intricacies of a Managed Care PlanA Managed Care plan will typically restrict the individual to visiting in-network set of physicians, hospitals and health care providers. This encompasses the Group Health Insurance plan, usually extended as part of an employer benefit. A single policy is designed for a big group of individuals belonging to different age groups and with varied medical conditions. Due to the economies of scale, in terms of risk distribution, these plans have lower premiums and out-of-pocket expenses than the private health insurance plan. There are three variations of the Managed Care plans: PPO (Preferred Provider Organization), HMO (Health Maintenance Organization) and POS (Point-of-Service). The in-line exclusions of these plans are a major concern, which are probably not always evident to the policy holder till the unforeseen happens. The provisions in the policy are decided between the insurer and the policy owner (typically your employer). Due to the restrictions imposed to visit doctors registered with the plan, you may come across a situation where you do not have a doctor to treat your specific illness. Simple surgeries and diagnostic tests can add up to thousands of dollars in medical expenditures due to the exclusions. In the long run, the lower premiums may not actually save your money due to these occasional exclusions/limitations. Thus, it always becomes an annoyance for the consumer to choose a well-rounded managed care plan that covers all or most of the medical diseases and/or illnesses. The bureaucracy and red tape involved in these policies to obtain authorizations and referrals even for the slightest of variations, for cost control measures always lead to a lot of dissatisfaction. Typically, you are also required to go through a primary care physician (PCP) for any of your treatment needs and may not be able to get your treatment done with the doctor of your choice to avoid excessive costs to the insurer. « Previous Page « » Discuss it » Continue Reading »
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