Gatekeepers are responsible for arranging the patient's referral to a specialist or admission to a hospital. POS plans give the patient the opportunity to see providers outside of the network . Patients who use the HMO network of providers pay less than patients who see providers outside the network . PPOs seek to manage medical costs by contracting with a network of providers who are willing to accept lower reimbursement rates. In addition, PPOs usually use other methods, such as utilization review , to control unnecessary utilization.
Patients can choose any health care provider.
But they will have to pay additional money if they use a provider who is not part of the network . PPOs are frequently used by traditional insurance companies. This document starts with some general advocacy tips , followed by a list of important questions and tips related to the health plan selection process. We recognize that you may not have time to ask every possible question about health care when you are faced with a choice of health care plans. You should tailor the questions to meet address your family's health care needs.