提上來回答什麽是PPO, HMO等保險計劃

by 也潛水

PPO- preferred provider organization

A PPO (Preferred Provider Organization) is a network of doctors,hospitals and other health care providers that have been contracted byan insurance company or health plan to provide care at a discount. PPOPlans have two benefit schedules -- one for In-Network and another forOut-Of-Network services.

PPO 一般可以去network裏麵任何專科醫生或醫療機構看病,
由保險公司支付承諾的費用,病人自己隻要承擔少量費用. 但
在network以外的地方看費用比較高. 好處是可以在network
裏任意選擇醫生(大多數的醫生都和幾個主要的PPO保險簽的),
醫生在保險範圍內會盡量給最好的治療. 缺點是出了network
的醫生自付部分相對高.

HMO- Health Health Maintenance Organization

Each HMO member selects a Primary Care Physician (PCP) from a directoryof participating physicians in the areas of general practice, familypractice, internal medicine or pediatrics. The PCP will coordinate allof the member's health care needs. If the PCP can effectively providecare, he will. If he determines a specialist is needed, he will referthe member to a Participating Specialist in the HMO network.

HMO最大的好處是自付費用非常低,由一位主要醫生負責
一般病情,主要醫生覺得他不能處理時推薦給專科醫生.
缺點是你不能自己選專科醫生,如果遇到自私或不負責的
主要醫生,你可能得不到最有經驗的醫生的治療. 另外如
果醫院本身就是保險公司(比如象Kaiser這樣的醫院),
盡量要節省成本,有時會有利益衝突.

POS- Point of Service
這是HMO和PPO混合的一種保險.
小毛病可以和HMO一樣找主要醫生看或聽從他選擇的專科
醫生,費用很低. 如果不滿意主要醫生的意見也可以找別
的醫生或不是他推薦的專科醫生看,但這部分自付費用比
較高.

Indemnity Plan
沒有network隻分,可以找任何醫生看. 缺點是自付費用
比較高.