As of May 2010, the health insurance industry provides many different types of service to its customers. PPO and POC are two of the many variation of managed health care that involves a network of physicians and providers to lower patient costs. These two types of health insurance vary with respect to physician referrals and out-of-network coverage.
Preferred Provider Organization
The Preferred Provider Organization, PPO, is a type of health insurance service that offers the greatest benefits to patients who see doctors on an insurance network. These "preferred providers" usually have reduced rates due to their arrangements with the insurance provider, and the PPO pays a percentage of all costs after a deductible is met. In a PPO, patients may freely choose among any doctor in the provider network to receive insurance benefits.
Point of Service
Point of Service, Point of Contact or Point of Care health insurance plans are all synonymous and may be abbreviated as POC or POS depending on the health insurance company. These plans are similar to a PPO in that they require patients to see doctors on an insurance network in order to receive the greatest benefits. Unlike a PPO, the Point of Contact is a primary care physician that must make all referrals to other doctors in order for insurance benefits to be provided. This contrasts with a PPO where patients need no formal referrals before seeing a networked doctor of any type.
Out of Network Coverage
A PPO and a POC health insurance plan offers the greatest benefits to patients who see in-network physicians. However these plans also provide limited coverage for doctors outside the health insurance network. This is a considerable advantage over more strict policies, such as HMO insurance plans that usually offer no coverage outside a network. However out-of-network coverage in a PPO and POC is usually reduced compared to in-network services. Patients will typically pay more for the same procedures and doctor visits than if they visited in-network providers.
Seamless Billing
The billing process in a PPO plan is often streamlined and more convenient than a POC. Before the correct benefits can be provided to doctors in a POC plan other than the primary care physician, the insurance must receive the referral information. This can increase the paperwork and time involved for all parties. Claims may need to be re-processed if the referrals were not properly attached or received by the insurance during the initial processing. In a PPO, any network physician bills the insurance directly without the involvement of any other physician. This efficiency can be a significant convenience compared with the POC process.
Medical History
While the need for referrals in the POC system may be inconvenient for some patients, it can offer increased medical care for others. By coordinating all doctor visits with specialists through one central physician, particularly complex medical conditions are more efficiently handled. The primary care physician monitors all test and procedures affecting the patient. This can reduce duplicate work among other doctors and ensure that specialists receive important information that the patient may be unable to remember.
Member Comments