What Are The Differences Between An MCO, HMO And PPO?

Review the detailsHealth insurance can be a very complicated subject when you factor in the different types of insurance policies that are available to the public. Understanding the differences of the various insurance policies available is essential to choosing the right insurance policy for you.

Managed Care Organization

A Managed Care Organization (MCO) is part of a Family Care Program that coordinates services from different existing programs and combines them into a single long-term plan of support and services based upon the needs and preferences of the members. MCOs improve the quality of services received by consumers.

Health Maintenance Organization

Health Management Organizations (HMOs) are also managed care organizations that offer enhanced healthcare services to members of the HMO. This type of insurance plan began in the early 20th century but grew in popularity with the passage of the Health Maintenance Organization Act of 1973. Under an HMO, the patient chooses a primary care physician who aids the patient in a comprehensive healthcare plan tailored to that patient.

Advantages of an HMO include:

  • Patients build lasting relations with their Primary Care Physician (PSP).
  • There are no deductibles and co-pays are minimal. Prices for prescription drugs are low because the HMO takes advantage of bulk rates for prescription drugs.

Disadvantages of an HMO include:

  • HMOs have restrictions that may interfere with the patient’s treatment. If a patient wants or needs to see a specialist, his PCP must first refer him to the specialist. Patients are also restricted to treatment at certain medical facilities.
  • For patients with pre-existing conditions, HMOs may refuse to cover treatment related to the injury, there may be a waiting period before treatment is covered or treatments may cost more.

Preferred Provider Organizations

Preferred Provider Organizations (PPOs) consist of a network of hospitals, healthcare facilities, physicians and labs that patient may choose from for services and the services will be covered under the insurance policy. PPOs are more flexible because patients may choose from several doctors within the network; however, patients who choose to go to doctors outside the network pay a larger percentage as a co-payment.

Advantages of a PPO include:

  • Patients do not require referrals to see a specialist.
  • Flexible plans allow insureds to choose from several different doctors and healthcare facilities within the network.
  • Paperwork is reduced allowing patients to receive treatment faster.

Disadvantages of a PPO include:

  •  Patients are responsible for their managing their own healthcare plan under a PPO.
  • Members typically pay a co-pay before they receive treatment.
  • Co-payments under a PPO are generally higher when compared to an HMO.

If you or a loved one have been injured by medical malpractice, you will need a lawyer with experience. Call Moseley Collins at (916) 444-4444 for a free consultation.

Moseley Collins is a personal injury attorney serving those badly hurt throughout California. There is absolutely NO FEE to discuss your case and there is absolutely no fee unless we win and get you the money you are entitled to. We are on your side and know what to do to get you compensation and justice.

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