Members choose how and from whom to receive services at the time they need them. Patients may choose to receive care from providers who do not participate in the PPO, with higher copayments and deductibles attached to services provided by non-participating providers. The provider receives, in advance, a negotiated monthly payment per member based on the expected cost of providing the specified services. Payment varies to reflect the total number of members covered. Payment does not vary based on the actual services provided to each member.
Primary care is provided as the patient's first contact on an outpatient basis.
A fundamental feature in managed care, whereby the managed care plan and its providers share financial risk for providing care to enrollees. The amount of risk incurred by the various parties depends on the specific contract between the health plan and its providers and the mechanisms for reimbursement. You may give each page an identifying name, server, and channel on the next lines.