Do doctors prefer HMO or PPO?
Do doctors prefer HMO or PPO? To answer this question, one needs know the benefits of having a PPO health insurance plan or having an HMO insurance plan.
There are different insurance plans but two most commons are PPO & HMO, Let’s have a quick look on the definition
A PPO stands for “preferred provider organization” and the patients who have a PPO plan or policy under whatever payer such as united health care, Humana etc.
They are going to have a lot of flexibility such as they can choose any provider they want to see. They can even see multiple doctors based on their health situation such as they can go to any specialty such as ENT, internal medicine or orthopedic.
In simple words they don’t require a referral or a prior authorization. This flexibility results in high costs which is reflected in the health insurance premium they pay to payers further the co-payments or deductibles can be higher as well.
Some people are willing to pay that extra money for the flexibility of seeing the providers they want to see. Especially if they have been seeing a certain provider for a certain health condition for a while and they feel comfortable with them.
A HMO stands for health maintenance organizations. HMO usually charge a little bit lower premiums, lower co-pays and lower out-of-pocket.
But the problem is that low cost restricts patients to see providers who are in specific network. That means that if your chosen provider is not in network of your HMO that will not be covered by your HMO insurance plan.
Sometimes there are HMOs that will allow people to go outside of the organization provider network with a referral authorization or a prior authorization.
No doubt, doctors prefer PPO over HMO as it’s more flexible for patient and gives more revenue to providers.
HMO vs PPO for Providers, things to know.
We have concluded that common plans that providers or physicians will find with patients coming into their practice will be the PPO & HMO plans. The same also applies for telemedicine practice, we have detailed article on how to set up a telemedicine practice.
Providers needs to be careful if the patient they are seeing is having HMO insurance plan or PPO. If your patient does happen to have an HMO then provider needs to make sure the following.
Provider must be in network.
- The patient has the prior authorization.
- Provider need to make sure that you’re staying in the approved scope.
- Provider can educate that patient and let them know that they might be have to pay for
- Their services, if it wasn’t approved because you’re not an HMO provider in that network.
Therefore being a provider you should make sure that your staff understands what the difference between a PPO and an HMO is? Further, You can always widen you patient acceptance by credentialing providers with all the important payers in the area.
The staff should make sure that provider is treating right patient by looking for patient cards and by asking the right questions to patients such as you can ask them.
If they’re new to your practice to make sure that you’re not seeing anybody you shouldn’t.
This will save you losing out on any money. The patients will also be protected being responsible for a huge bill because they were not aware of the certain restrictions.
Most of the time the insurance card will clearly say PPO, HMO, EPO or POS but if it doesn’t then you can check eligibility and benefits.
By checking eligibility and benefits you can confirm what kind of plan it is and you can usually tell by the things that are covered and the requirements and the um out-of-pocket requirement expenses for patients.
This will save a provider being seeing a bunch of HMO patients without referrals or prior authorization and losing out on that money.
