Health Maintenance Organizations, prepared by Ruth H. Stack and William G. U5 T8 Group Health:
Posted on June 11, by sollila The term HMO stands for Health Maintenance Organization, meaning a health plan that provides prepaid health coverage for hospitals and physicians.
Members of an HMO health insurance plan are required to use specified providers that participate in the plan. They are also enrolled for specific periods of time.
Members are able to choose a primary care physician PCP that is part of a contracted provider network. The member is not typically responsible for submitting insurance claims.
If seeking specialized care not within their PCP, the member must have an authorized referral. Preventative care benefits are often included with an HMO. There are four basic types for HMO models: IPA or Independent Practice Association is where physicians practicing in their own offices partake in a prepaid health care plan.
These physicians charge rates based on an agreed-upon amount to enrolled patients.
They in turn bill the IPA on a discounted fee-for-service basis. Services in these models are offered at HMO-owned health centers. There are two types of group HMO models: When enrolling in a HMO health insurance plan in Wisconsin, you should fully understand the limits of the network providers of the plan before enrolling.As health care in the United States has been changing rapidly over the past two decades, so has the way health care has been provided and how it is billed and paid.
Large insurance companies and private physicians have given way to HMOs and managed care plans and the TPA has been prospering.
Performance Measures for Health Care Systems David R. Nerenz, Ph.D. Michigan State University Nancy Neil, Ph.D. Care Systems Objectives In this paper we will briefly summarize the history of performance measures for hospitals, health plans, and health care systems. We will describe some of the key design considerations that go along.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna).
Health benefits and health insurance plans contain exclusions and limitations.
Mammograms: A Health Maintenance Organization (HMO) contract, individual health policy, group health plan, or an out-of-state association group or trust certificate must include coverage for a baseline mammogram for a woman age , a mammogram every two years for a woman age , every year for a woman age 50 or older, and one or more a.
The health maintenance organizations have existed since the early 20th century, but they didn't settle into the current form until the Health Maintenance Organization Act of set federal rules that defined their operation.
MercyCare Health Plans 3 MercyCare Health Plans The MercyCare Health Plans complies with applicable Federal civil rights laws, to include both Title VII of the Civil Rights Act of and Section of the Affordable Care Act.