What is the difference between traditional health insurance and managed care?
A health insurance policy is a traditional plan which provides security to you and your family for lifetime. Traditional care is a healthcare plan that tends to be a more expensive option with the most flexibility in choosing a healthcare provider. Managed care plans, as the NC Medical Journal explains, strive to provide health care services to members at the lowest cost possible.
With traditional ( indemnity ) insurance, you can select any doctor or hospital at the time service is needed. You do not need a referral to see a doctor. Under managed care, doctors, hospitals and other health care providers contract with the health plan to form networks that deliver health care services. Normally, you will select providers from within those networks to get the maximum coverage available through the health plan. Some managed care plans, such as point-of-service ( POS ) plans and health maintenance organizations ( HMO ) require you to select a primary care physician. In an HMO, the primary care physician coordinates your care and refers you to specialists. In POS, the primary care physician has the same function, but you have the option to go directly to a specialist at a lower benefit level.
With traditional (indemnity) insurance, you can select any doctor or hospital at the time service is needed. You do not need a referral to see a doctor. Under managed care, doctors, hospitals and other health care providers contract with the health plan to form networks that deliver health care services. Normally, you will select providers from within those networks to get the maximum coverage available through the health plan. Some managed care plans, such as point-of-service (POS) plans and health maintenance organizations (HMO) require you to select a primary care physician. In an HMO, the primary care physician coordinates your care and refers you to specialists. In POS, the primary care physician has the same function, but you have the option to go directly to a specialist at a lower benefit level. The Role of the Primary Care Physician Managed care plans reestablish the role of “family doctor” by encouraging a steady relationship between you and your primary care physician (usual
A10: With traditional (indemnity) insurance, you can select any doctor or hospital at the time service is needed. You do not need a referral to see a doctor. Under managed care, doctors, hospitals and other health care professionals contract with the health plan to form networks that deliver health care services. Normally, you select doctors and hospitals from within those networks to get the maximum coverage available through the health plan. Managed care plans offer consumers comprehensive health services and provide financial incentives for patients to use in network doctors and hospitals. You must also usually receive approval from your plan before you can be admitted to the hospital or see a specialist. Some managed care plans, such as health maintenance organizations (HMOs) and select point-of-service (POS) plans, require you to choose a primary care physician. In an HMO, the primary care physician coordinates your care and refers you to specialists. In POS, the primary care phys
