Please help cure my ingnorance...

[LusuR]

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Well it's interview season for me, and I'm dreading that I'll have to talk to an interviewer about HMOs, insurance plans, deductibles, etc...

I don't know the difference between an HMO and a turkey on rye. Does anybody know of any good books or websites where I can learn about insurance plans, HMOs, and all that garbage?

Scholads of thanks!

 

[bkpa2med]

Your best bet would probably just to google it.

 

[Canuck99]

I could be completely wrong, but I highly doubt that any interviewer would ask specifically about the differences between medical insurance plans. it is more likely that a general question about insurance would be asked. however, it is always good to be well informed so, yes, googling it would be a good idea.

 

[atrovariousg]

An HMO is an organization and as a member, you agree to play by their rules, see their doctors, get needed referrals and follow their idea of indicated care. They offer little assistance financaily should you not follow their rules to the letter.
Insurance on the other hand throws a slightly larger blanket shal we say of coverage in that they will cover a greater percentage should you see one of their preferred providers, but may cover you to some extent should you go elsewhere.
Just be aware that in both cases, but especially in the case of HMO's someone besides your doctor may make most of the decisions regarding your treatment.

 

[supersash]

ahhh, a question that is close to my heart!! i work in a an ob/gyn office, and this all i hear/talk about all day!

as atrovariousg said, an HMO plan doesnt give you options. you can only see the doctors on that plan's list. an insurance plan (usually a PPO or POS) gives you more options. you can see the doctors they list, and just pay your copay (usually between $5-$30), or you can go out of network, and see any doctor you like. a plan like this has a deductible, sometimes as low as $100, others as high as $10,000. once you meet your yearly deductible, the insurance company will reimburse you, usually around 70-90%.

PPO's are always the way to go. as a patient, you get the most options and are in charge of your own health care. like stated earlier, an HMO doesnt give you freedom, you always have to answer to your primary care doctor. many times you cant even see a specialist (or the plan wont cover the costs), unless your primary care gave a referral.

PM me if you have any specific questions. but i also agree w/canuck, they probably wont ask for direct defintitions, but i am sure they would be impressed if you knew a bit about it.

hope this helps a bit!
sasha

 

[Raven Feather]

Well it's interview season for me, and I'm dreading that I'll have to talk to an interviewer about HMOs, insurance plans, deductibles, etc...

I don't know the difference between an HMO and a turkey on rye. Does anybody know of any good books or websites where I can learn about insurance plans, HMOs, and all that garbage?

Scholads of thanks!

HMOs are managed care, they only allow for certain diagnoses for tests to be covered, only give so many days in hospital for x or y diagnoses to be covered. The big problem with this is basically the insurance company is dictating the patient's care, not necessarily the attending doctor. Hospitals have Case Managers who keep track of what docs are doing with the patients, sort of like the insurance company's advocates (but in the best interest of the hospital so they will get their money too by the HMOs!)

PPOs, is where docs sign a contract with insurance companies to give patients with ppos participating discounts, doc gets less of one hounding his or her back to boot someone out of the hospital because it has been the 3 allowable days for the x or y diagnoses. The thing with this in contrast to HMOs is they get less of a reimbursement by the insurance co. for their work is what I was told.

Hope this clears things up for you and didn't sound too confusing.

 

[Punchap]

One of the books required for my health policy course is:

Understanding Health Policy, by Bodenheimer and Grumbach
-This book includes a general understanding of most current health issues, also explains HMOs, PPOs, ind./private health insurance plans, deductibles, malpractice, etc. Goodluck.

 

[atrovariousg]

Nicely put sasha! 👍