| Health insurance plans have been forced
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| | require referral from the primary care
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| to take action to contain costs of
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| | provider. This cost containment strategy
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| quality health care delivery as health
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| | is intended to avoid duplication of
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| care costs have skyrocketed. Health
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| | services (for example, the cardiologist
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| insurance premiums, deductibles and
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| | ordering tests that have already been
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| co-pays have steadily increased, and
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| | done by the PCP, or a sprained ankle
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| health insurance companies have
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| | being referred to an orthopedic) and
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| implemented certain strategies for
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| | avoid unnecessary specialist referrals,
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| reducing health care costs. "Managed
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| | tests and/or procedures.
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| care" describes a group of stratgies
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| | HMO and PPO plans also contain costs by
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| aimed at reducing the costs of health
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| | requiring prior approval, prior
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| care for health insurance companies.
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| | authorization, or pre-certification for
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| There are two basic types of managed care
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| | many elective hospital admissions,
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| plans; health maintenance organizations,
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| | surgeries, costly tests and imaging
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| or HMOs, and preferred provider
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| | procedures, durable medical equipment and
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| organizations, or PPOs. So which health
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| | prescription drugs. When such services
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| plan is best? How do you choose what
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| | are required, the provider must submit a
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| type of health insurance best suits the
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| | request to the health insurance plan
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| health care needs of you and your family?
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| | review department, along with medical
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| Both HMOs and PPOs contain costs by
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| | records that justify the service. The
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| contracting with health providers for
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| | request is reviewed by the health
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| reduced rate on health care services for
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| | insurance company to determine whether
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| its' members, often as much as 60%. One
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| | the services are justified as "medically
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| important difference between HMOs and
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| | necessary" according to the health plan
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| PPOs is that PPOs often will cover the
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| | policy and guidelines. Review is usually
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| costs of care when the provider is out of
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| | performed by licensed nurses, and, if the
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| their network, but usually at a reduced
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| | reviewer agrees that the service is
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| rate. On the other hand, most HMOs offer
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| | necessary, approval is given and the
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| no coverage for health care services for
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| | service will be covered by the health
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| out-of-network providers.
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| | insurance plan.
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| Both HMO and PPOs also control health
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| | As health care costs continue to rise,
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| care costs by use of a gateway, or
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| | many indemnity health insurance plans, or
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| primary care provider (PCP). Health
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| | "fee for service" plans are being forced
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| insurance plan members are assigned (or
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| | to adopt some managed care strategies in
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| select) a primary care practitioner
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| | order to provide quality health care and
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| (physician, physician assistant, or nurse
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| | keep health insurance premiums
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| practitioner). usually a family
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| | affordable. And as long as health care
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| practitioner or internal medicine doctor
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| | costs continue to rise, the distinctions
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| for adult members or a pediatrician or
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| | among PPO, HMO, FFS and other health
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| family care practitioner for childern.
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| | insurance plans will become blurred.
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| The primary care provider is responsible
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| | Rest assured, however, that managed
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| for coordianting health delivery for plan
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| | health care is here to stay.
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| members. Care by specialist physicians
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