Arizona health insurance companies have done their level-best over the years to use as many letters as possible to describe a wide variety of insurance products… PPO, HMO, EPO, POS, HDHP, HRA, HSA, and WOW, that is confusing!
In the not so olden days people simply paid cash for medical services. Then along came insurance plans that worked much like Medicare does today, the patient and insurer sharing in the cost of a major medical claim.
With a wide variety of health insurance plans to choose from today it is very important to understand the rules of the insurance product you have enrolled in.
Each of the following products have very specific rules that must be followed in order for a claim to be paid. The rules and guidelines will be supplied to you at time of enrollment, and likely may be found online on the carrier’s website. Health Maintenance Organization (HMO,) Exclusive Provider Organization (EPO,) Point of Service Plan (POS,) Preferred Provider Organization (PPO,) High Deductible Health Plan (usually paired with a Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA.)
The main goal of all of these plans is to control the ever-increasing cost of healthcare. These attempts to control costs come with a fair amount of confusion for most policyholders. There are PPOs with in-network benefits in addition to a national network when travelling, PPO plans with regional networks and out-of-network benefits, and PPOs that are open access (coverage in or out of network.) Some HMOs have physical addresses while others contract services with private physician offices.
Having a general understanding of how your health plan works before medical care is required will go a long way in lessening the chance of having a claim denied, and you on the hook for a large bill.