What is a PPO?

PPO – Preferred Provider Organization. PPO allows patients to see a specialist without a referral from a Primary Care Physician. PPOs usually have a wider range of doctors to choose from when compared to HMOs. The direct access to specialists is good for people who have chronic illness, or in case of urgent care and emergencies. Patients can get appointments with their preferred specialists as and when required. Usually, a PPO will pay a greater percentage of the cost for a preferred provider and less for a non-preferred provider. Advantages of PPO: Patient can visit any doctor and hospital. They […]

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What is a HMO?

HMO stands for Health Maintenance Organization. HMO is a company that offers health plans, that provides medical care from an approved network of doctors, hospitals, and pharmacies. The patient needs to pay a preset minimum fee per visit. The HMO fees are usually lower than PPO (Preferred Provider Organizations). The advantages of HMO: No or very low deductibles Comprehensive benefits Preventive care is often good The disadvantages of HMO: HMO plan includes only a particular chain of hospitals and doctors The patient must see doctors within the network The patient must get permission from the primary physician to see a […]

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What are pre-existing conditions?

Pre-existing conditions are medical ailments for which you have already received or are receiving treatment for. Pregnancy, AIDS, high-blood pressure and stroke are all forms of pre-existing conditions. Different insurance carriers have their own policies for pre-existing conditions. Some insurance providers offer coverage after a certain waiting period while others totally exclude certain conditions. Having a pre-existing condition obviously puts you at a higher risk for compensation than people without pre-existing conditions and is therefore more difficult to get insurance cover.

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What is the meaning of UC & R?

UC&R (or Usual, Customary & Reasonable): UC&R (or Usual, Customary & Reasonable) Charges represent the average or most common amount charged by providers for a particular service, treatment, or supply in the same geographic area. Typically information on rates for procedures is compiled into a data bank and updated periodically. So when a claim is submitted for a plan with UC&R benefits, the insurance company before making the claim payment reviews the UC&R rate and double checks that hospitals and doctors are not billing excessively for the particular service or procedure. Most well respected plans from Blue Cross, Aetna, Lloyds, […]

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