A POS HMO is similar to a standard HMO but allows for out-of-network doctors at a higher cost. Referrals to specialists can come from the primary care physician or be self-referred. Membership is more expensive and out-of-network fees can be high.
A POS HMO (Health Maintenance Organization Point of Service) functions much like a standard HMO. There can be several differences and HMO POS can in general be more expensive because these differences are more expensive and give you more access to the service. It should be noted that both plans tend to require people to have a primary care physician overseeing medical care.
In most cases, people in an HMO need to see their primary care physician and see other specialists who are part of the organization. Coverage is typically not offered at all if people are not using a network doctor. Some of the appeals of the HMO are low co-payments and predictable service charges.
This changes when people have a POS HMO. There is the option to see doctors out of the network, although it costs significantly more to do so. With an online GP, people only pay for what they’re responsible for. When leaving the network, people can pay 50% or more of the total costs. However, if this is feasible, choosing an HMO POS option may be useful if the HMO is not contracted with a person’s current doctor.
Another difference is how HMO POS works when it comes to specialists. In a regular HMO plan, all referrals must come from the primary care physician. When people see a specialist without a referral, these services won’t be covered. In POS HMO, people can self-refer. A specialist visit is likely to be covered if they use a specialist contracted with the HMO, but not at full cost, although this can vary. Even self-refers to out-of-network specialists receive only a percentage of coverage instead of the usual copayment.
There is a difference when the GP makes the referral. He or she can refer a patient to a network or non-network specialist and the visit can be covered for the same fee. Provided people can wait for a referral, they may be able to see any specialist recommended by their primary doctors, whether or not that person participates in the HMO.
While there are advantages to HMO POS, there are some disadvantages as well. Because of the potential for these plans to be more expensive than standard HMOs, membership typically costs more. Fees can still be high when people see out-of-network doctors, and those who can’t afford these fees have their choices pre-limited by their economic status. It’s good to decide whether the choice extra expense that comes with these plans is worthwhile or affordable.
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