No. The HMO pays for covered services only if you
use network providers. In a medical emergency, the HMO will also
pay for covered services from a non-network provider.
|
Yes, but you usually pay more than if you go to
a network provider. |
Yes. You may get care from any provider. |
You are charged a copayment (usually between
$5 and $25) for a doctor’s office visit and most other services.
There is usually no deductible.
You usually do not need to fill out claim forms.
|
If you use a provider who is in the network, you pay a copayment,
but no deductible. You do not have to fill out claim forms.
If you use a provider who is not in the network: after you pay
a deductible, you pay coinsurance (usually 20–40%) and the
insurer pays the rest up to the insurer’s allowed amount.
If your provider bills more than the allowed amount, you also must
pay the difference between the billed and allowed charges (balance
billing). You may need to fill out a claim form.
|
After you pay a deductible, you pay coinsurance (usually 20–30%)
and the insurer pays the rest up to the insurer’s allowed
amount. If your provider bills more than the allowed amount,
you also must pay the difference between the billed and allowed
charges balance billing).
You will need to fill out a claim form.
|
| You usually need a referral, although in many HMOs
some types of specialists may be available without a referral. Some
HMO products allow visits to most specialists in the network without
a referral. |
Depends. You usually need a referral only if you want to see a
specialist and receive in-network benefits. Some POS products allow
visits to in-network specialists and provide in-network benefits
without a referral.
If you use a provider who is not in the network, you usually do
not need a referral, but you will pay more than if you go to in-network
providers.
|
You do not need a referral to go to a specialist. |
