POS Health Insurance Plans
POS health insurance (Point of Service Plan) is a hybrid of the PPO (Preferred Provider Organization) and the HMO (Health Maintenance Organization). If you access their large network of hospitals, doctors, specialists and other health care professionals you pay a lower rate. The good news is if you need to see a doctor or specialist outside the network they will still pay only a lower percentage of the bill. You have the same arrangement as the HMO where you select a primary care physician and he refers you to a specialist. The specialist can be in or outside the network.
When you are billed for an out of network procedure or visit it is your responsibility to gather the paper work and submit the claim. You can't call up the dermatologist on your own like with a PPO. But it still is less expensive than a PPO when billed for using an out of network doctor. The down side is some POS's require you pay the out of network bill then submit the invoice to them for reimbursement but the deductible is far more affordable than the POS's for almost the same freedom of choice. The net care co-pays are low and there are nodeductibles to meet. This one point may allow you the extra splurge now and again to use a specialist outside the network.
When considering a POS plan find out what is excluded. This may be a factor in the long run such as nursing home care, physical therapy, maternity and post op care.
Find out what the POS defines as an emergency before you use the emergency room. Also, find out if you need authorization from your primary care physician before using the emergency room facility.
Questions To Ask When Choosing A POS
What Does Your POS Include?
Many policies have wellness programs they will cover. Or offer educational materials and disease management programs to encourage less medical intervention. Diabetes is a primary example of teaching people how to prepare their meals, check their blood sugar levels, or what to do if they are eating at a restaurant. There can also be mammograms, an annual physical or other preventative health screening procedures covered by the POS plan. After all, an ounce of prevention is worth a pound of cure.
The POS plans vary greatly on what they cover. So when you are comparative shopping make sure you are comparing the same or similar coverage. For example if they cover physical therapy they may limit the number of visits they cover.
Tips For Using POS Health Insurance
The downside of offering hybrid services makes for communication breakdowns. The doctor's office may think one thing while the lab thinks another. So keep a log and read thoroughly the policy brochure so when questioned you can answer with confidence.
Even more important to prevent being billed for a procedure you thought was covered by the plan. Read thoroughly what the policy covers and what it excludes. What facilities or more compassionate and thorough regarding patient care and if that facility or medical group is in your POS providers network.
The last thing to consider is to have a H.S.A. plan (Health Savings Account). Then you would need a policy which coordinates with the H.S.A .plan. This could be a terrific safety measure. For when you elect to access medical assistance outside the network you would have the money already put aside for that particular expense. Compare POS Health Insurance Plans Today!
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