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Running Head: Point of Service Plan

Point of Service Plan Matthew Mabalot HCA 600 Week Three Assignment National University

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Point of Service Plan The point-of-service (POS) plan is a combination of both a Health Maintenance Organization (HMO) and Preferred Provider Organization (PP0). Health insurance companies offer the option of either an HMO or PPO, and the hybrid plan called the POS. The POS plan was developed to offer the best of both worlds in regards to the HMO and PPO plans. Knowing the differences between an HMO and POS plan makes a difference in choosing the right plan for a patient. The PPO plan offers patients the choice to see any provider they wanted to regardless of whether or not the physician is in network or out of network or not. The HMO plan requires patients to only see in network Primary care physicians and can only see Specialists in network with prior authorization from their Primary Care Physician. It is very difficult trying to decide which plan to choose between and HMO and PPO, which is the reason the POS plan was created and use more often. Patients choose their plan based on their health care and affordability needs, which is the reason for different plan options. The HMO offers patients a network of doctors to choose from and handles their health care through managed care. The benefits of having an HMO are having a Primary Care Physician (PCP) who manages the patients care throughout the plan and at the same time get a lower rate for health care services. HMOs may not be the best plan for patients who want to see providers outside of the network because HMOs have strict policies. Rates are much higher when patients go out of network with an HMO plan because the services will not be covered by the health insurance plan. Patients prefer PPO plans because they have the flexibility to choose any provider and see any specialist out of network anytime without having prior approval or authorizations. The

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issue with choosing a PPO is the higher cost to go out of network but is normally a higher coinsurance or a deductible that is paid out of pocket. The benefits of a PPO plan are the patient doesnt have to choose a primary care physician and can receive services out of network anytime they want and still be covered. Both PPO and HMO plan have their benefits and their constraints which made it difficult for patients to choose the right plan. The Point-of service plan started to grow in the health insurance world because it offers both benefits from the HMO and PPO. The Point of service plan uses the managed care system like the HMO by having a network of physicians that work together in providing quality health care and lowering health care services. The POS plan still requires patients to choose an in network physician but is still covered to go out of network to see specialists as long as there is prior approval from the in network PCP and the information is documented and sent back to the managed care providers. The in network PCP becomes the point of service in which the patient will receive health services. Like a PPO, the patient has flexibility to choose the physician and still get a lower rate based on the service provided out of network. Patients only have to pay a co-payment for out of network services where a traditional PPO plan would have costs a higher out of pocket deductible. The POS plan started to become more popular because patients were offered lower costs and covered out of network service costs. The main focus point of the POS plan is receiving the benefit of having a PCP who is responsible for the utilization of services provided to the patient which was adopted by the HMO and can still managed the services when going out of network. The POS plan grew popular because patients became more interested in having the choice of which providers they were allowed to see. Patients preferred a POS plan to have the luxury of both worlds and became a more common plan to choose from. As the plan became

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more popular, health insurance companies were able to see a trend in the hybrid plan and started adapting to the plan to stay in competition with other health insurance companies. HMOs started to be less strict on the services being utilized by authorizing more services and managing the health care in a larger network of doctors and hospitals. The larger the group, the lower the costs were because all the services can be maintained, managed, and allocated in a central location in a medical group.

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References

Shi, L. and Singh, D. (2008) Delivering Health Care in America. A systems Approach. Jones and Bartlett Publishers, Inc. 106, 197-237.

Bohnsack, J., & Hawig, S. (2012). Choosing the right strategy for point-of-service collections. Hfm (Healthcare Financial Management), 66(9), 122-130. Hagland, M. (1996). Point-of-service: Staying alive. Hospitals & Health Networks, 70(20), 5858. Retrieved from http://ezproxy.nu.edu/login?url=http://search.proquest.com/docview/215306194?accountid=2532 0 Stahl, D. A. (1996). Capitation, point of service and medicare select: Friends or foes. Nursing Management, 27(12), 15-18. Retrieved from http://ezproxy.nu.edu/login?url=http://search.proquest.com/docview/231410015?accountid=2532 0 Woodcock, Elizabeth W, MBA,F.A.C.M.P.E., C.P.C. (2008). Point-of-service collections. Dermatology Times, 29(8), 84-84,94. Retrieved from http://ezproxy.nu.edu/login?url=http://search.proquest.com/docview/231113525?accountid=2532 0 Grimaldi, P. L. (1996). Medicare's point-of-service. Nursing Management, , 14-14. Retrieved from http://ezproxy.nu.edu/login?url=http://search.proquest.com/docview/231423875?accountid=2532 0

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