Managed care is an approach to healthcare that aims to keep costs low. Health insurance plans using this approach negotiate lower rates for basic procedures and offer a network of qualified doctors. However, there are potential liabilities, such as decreased benefits for choosing a doctor outside the network or needing a referral for a specialist. It is important to evaluate the specific plan to determine if the benefits outweigh the responsibilities.
Managed care is a term used to describe an approach to health care that involves a conscious effort to structure the process of obtaining health care in a way that helps keep expenses as low as possible. Many of today’s health insurance plans are designed with this idea of managed care in mind, often using specific strategies to ensure that the procedures performed are in the best interests of the patient and are not performed simply to create massive medical bills. While the general concept of managed care is attractive, there are also some potential liabilities that need to be considered as well.
One of the advantages of managed care is that health insurance plans that use this approach often negotiate lower rates for basic health care procedures with doctors, laboratories, and various types of health care facilities. What this means for the patient is the ability to get basic medical care at a lower cost. This in turn makes it much easier to seek medical attention when needed, without worrying too much about the impact that a visit to the doctor or a stay in the hospital will have on the household budget.
Another advantage of managed care is that many health insurance plans operate using a wide range of doctors and specialists who are connected to the insurance provider’s network. In some situations, this can make it much easier to locate a particular type of doctor when needed, allowing you to choose from a number of different medical professionals when specialized treatment is needed. For people who may be a little intimidated by having to find and qualify specialists for necessary medical procedures, having a managed care plan include a list of doctors who have already been qualified by the insurance provider can be extremely helpful. .
While managed care programs often provide a valuable service, it is important to note that there are some potentially adverse circumstances that may prevail. Choosing to use a doctor who is not in the plan’s network may result in a decrease in benefits paid, or even in the denial of all claims altogether. Also, just because a particular doctor is in a network doesn’t mean they’re automatically available. It may still be necessary to seek care from another medical professional to obtain the highest level of benefits. Even then, some patients may find it necessary to wait a considerable amount of time before being able to schedule an appointment, especially if that available doctor is carrying a higher patient load.
Getting services from a specialist is also sometimes more complicated with managed care. With many such plans, a referral to a specialist by a general practitioner may be necessary before the insurance provider will cover the costs of that visit. The same goes for procedures that need to be done in a hospital or surgical setting. Simply put, the patient cannot bypass the general practitioner and choose to go directly to a specialist or arrange for a procedure and expect insurance to cover the cost.
It is important to note that the specifics of the health insurance plan will have a significant impact on the benefits that are provided to the insured party and what potential liabilities may be present. Since there are several different types of managed care plans today, some allowing patients greater discretion in the selection of physicians and control of their own health care needs, it is very important to evaluate the specific plan and decide if the benefits outweigh the responsibilities. Doing so can mean the difference between being able to get quality care when needed and having to find ways outside of the plan to subsidize health care needs that are desired but not considered necessary or covered by the terms of a plan.
Smart Asset.
Protect your devices with Threat Protection by NordVPN
