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Managed Care

Managed Care

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Published by: ocirs on Feb 27, 2008
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10/14/2011

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HMO vs. POS
Although the Point of Service plan provides coverage outside of the network, while HMOs do
not, consumer satisfaction has typically been higher for the HMO. It seems that the opposite
would be true. After all, consumers say that they want choice. The problem for the POS is that
the payments made for out of network service do not cover every dollar that the doctor or
hospital wants to receive. Remember that when the member goes out of network, the provider is
not bound by a contract to that network. The provider can charge his maximum rate. The POS
plan on the other hand, may reimburse the out of network provider at a lower rate then the in
network provider. This leaves the insured to pay the difference. This causes dissatisfaction with
the POS.

A Better CE

All Rights Reserved, Richard Levine

18

Lately however, Point of Service plans have been closing the gap in satisfaction with HMOs.
One year, 52 percent of HMO insured said that they were highly satisfied. That was a five
percent drop from 57 percent. Point of service plans gained five percent, and ended the year at a
51 percent satisfaction rate, 51 to 52 percent. It is now very close. Point of Service plans intend
to close the gap by improved performance in two measurements. 1. Overall quality of medical
care is improved, and 2, improving the level of concern that the plan shows for the members’
well-being.

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