Word: hmo
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Cases against HMOs have their place - but it's not in federal court. In a unanimous decision, the Supreme Court ruled Monday that health maintenance organizations cannot be sued under federal law. And while HMOs viewed the decision with jubilation, it hardly heralds the end of anti-HMO litigation; the Justices' opinion left the door wide open for cases to be heard in state courts...
...POSs or PPOs require PCPs? Woe is the new hire who must choose from a menu of health-care plans: a health-maintenance organization (HMO), preferred-provider organization (PPO), point-of-service program (POS) or fee-for-service plan (FFS). An explanation...
...HMO Designed to lower costs by centralizing care. A member must choose a primary-care physician (PCP) from a network roster upon joining. He can visit this physician to his heart's content, unless his heart's content requires a cardiologist, in which case he'll need a referral. That's why PCPS are also called gatekeepers...
...gatekeeper means more direct access to care. Recently, PPOS have emerged as the leaders of the pack. Most adopted a $10 co-payment to MDs within their networks, originally an HMO feature. Unlike HMOs, the PPOS do not require their doctors to seek approval before performing services. PPOS have also become more competitive as HMO premiums have risen...
...This option was created by HMOS to let members see doctors outside the network, but freedom predictably comes with a higher price. An HMO with broad networks like CIGNA's, though, only has a small fraction of POS members actually seeking care outside the network...