Who am I
HMO similar to an individual practice association except that the HMO contracts directly with the individual physicians.
What is a direct contract model?
A type of health maintenance organization that provides physical and mental health services.
What is a full service HMO?
Plan in which providers maintain their own offices and identities and see patients who belong to an HMO and those that do not.
What is an Open-Panel plan?
Patients may only select providers in the network. If they select a provider outside the network without approval, they will pay the entire bill.
What is an HMO?
Health maintenance organization that has multiple provider arrangements, including staff, group, or individual practice association structures.
What is a network model?
HMO that contracts with independent, multispecialty physician groups who provide all healthcare services to its members. Physician groups usually share the same facility, support staff, medical records, and equipment.
What is a group model?
Describes certain HMO plans in which the provider network is a combination of delivery systems.
What is a mixed model?
A plan composed of a network of individual or groups of healthcare providers who entered into written agreements with a third party insurer to provide health insurance coverage to those individuals enrolled in the plan. Must go in network.
What is Exclusive Provider Organization (EPO)?
Closed panel type of HMO in which a multispecialty group of physicians is contracted to provide healthcare to members of an HMO and is compensated by the contractor via salary and incentive programs.
What is a Staff Model HMO?
Individual healthcare providers who provide all needed healthcare services for a HMO.
What is an Independent Practice Association (IPA)?
Group of medical providers, physicians, clinics and hospitals that skips the insurance company intermediary and contracts directly with patients. Members pay a premium and a co-payment each time a service is rendered.
What is a provider-sponsored organization (PSO) ?
Also known as Consumer Directed Health Plan. These plans include high deductibles that the patient/family is responsible for before insurance will pay.
What is a high deductible health plan?
Group of hospitals and physicians that agree to render services to a group of people, generally under contract with a private insurer. Can go in or out of network.
What is a Preferred Provider Organization (PPO)?
"Hybrid" type of managed care that allows patients to either use the HMO provider or go outside the plan and use any provider they choose. Also called "open ended HMO".
What is a Point of Service (POS) plan?
Healthcare organization that provides only mental health services. It is separate from physical healthcare service provider.
What is a Managed Behavioral Healthcare Organization (MBHO)?