More and more of our patients are covered by “managed care” health insurance. Managed care plans can usually be identified by the acronyms HMO, PPO, MCO, PHO, OHP and the like. Our physicians are increasingly being asked by insurance companies to see managed care patients. They are often asked to sign managed care insurance company contracts, to which we agree, in exchange for patients insured by the plan to be referred to us. Most managed care plans have requirements for us to follow. Should we fail to follow those requirements, we can be prohibited from seeing patients covered by that plan. You, likewise, could incur increased health care costs—costs not covered by your insurance.
Managed care plans often have one or more of the following requirements:
We see only those patients with insurance referrals from a primary care physician (PCP);
There is a co-pay obligation by the patient, and;
Prior authorization and/or a second opinion are needed before surgery is performed.
There is a good chance that your insurance plan has one or more of these managed care requirements. If it does, we are obligated to follow them. These requirements may not always be pleasant or your medical treatment as timely as you would like, but they may be a part of your managed care program. Here are some common features of managed care plans:
PLAN
PRODUCT
Aetna Beech Street Blue Cross Blue Shield – HMO Illinois Blue Cross Blue Shield of Illinois Blue Cross Blue Shield Medicare Advantage PPO CIGNA Healthplan of Illinois, Inc.
