Starting this month, new protocols were implemented to regulate waiting times for California residents. These guidelines were primarily designed for HMO patients, but do extend to PPO’s as well. As it seems that more time is spent in the waiting room rather than with the doctor, these wait times provide some much needed relief. For the first year, the California Department of Managed Care will oversee that the rules are strictly followed, and health plans that fail to meet the wait times will find that they face possible fines and penalties. As it will be the insurer’s responsibility to meet the guidelines, it will also force the expansion of their provider networks to meet the need for timely care. The rules note the following maximum wait times:
Posts Tagged ‘ppo’
New Rules on Medical Wait Times
Friday, February 25th, 2011Understanding Insurance Terms
Friday, June 5th, 2009We all know how confusing insurance terminology can be. Here is a short list of the most commonly used terms to help you better understand the fine print on your policy:
HMO: refers to Health Maintenance Organization. HMO’s provides comprehensive health care by network physicians to those in a particular geographic area. With an HMO, you need to access care through a designated Primary Care Physician.
PPO: Preferred Provider Organization. PPO plan members receive full coverage by using doctors and hospitals within the PPO network, or they can pay more to go outside of the network for care.
What Does Concierge Medicine Mean?
Friday, May 22nd, 2009 These days you are probably hearing a lot about “concierge medicine”. This is where physicians charge patients an annual fee of several hundred to several thousand dollars a year to ensure benefits like longer appointments, shorter waiting times and the ability to call your provider directly. It has been reported that there are over a thousand physician groups nationwide who are currently operating concierge practices.
Critics claim that these practices result in many patients being driven to emergency rooms and family doctors who remain independent, resulting in overcrowding and long stays in the waiting room. Since there are fewer doctors going into primary care, this too will only add to an already strained system.
What is the Real Cost of Non-Network Providers?
Tuesday, April 21st, 2009Many people will find themselves in the position of dealing with a non-contracted provider.
What will this mean in regards to your insurance coverage? Depending on your plan, you may find that you now have little to no coverage for these procedures.
For example, many PPO plans will state that they cover 50% on non-network procedures.
However, it is important to realize that this means that they cover 50% of the allowable amount, rather than 50% of the overall procedure. Example:
Say you see a non-network provider and receive $1000.00 worth of care. The insurance company’s allowable amount for this procedure is $400.00.
