Understanding Managed Care Insurance Limitations

The issue of health care is a pressing one in the United States. It costs more here than in most other industrialized nations, and on top of that the country ranks somewhere in the middle when it comes to measurements of overall health and well-being. Basically, we pay a lot for less-than-perfect results. Part of the whole health care issue is managed care. It is a huge participant in American health care, if not the largest. Managed health care insurance comes in such forms as health management organizations (HMOs), preferred provider organizations (PPOs), and point-of-service plans (POS). If you’re a member of one of these types of managed care insurance plans – and there’s a very good chance you are – you should understand their limitations. Managed care will mean very different things to different people.

People who get their health care through managed care insurance plans often report frustration with their insurance plan limitations. These limitations oftentimes can be long waits to see doctors, or the inability to get the doctor of their choice. People can also face obstacles when they decide that they want to switch doctors. It’s important to remember that these managed care insurance systems are often comprised of networks of doctors and medical facilities, which is how the managed care insurance providers keep their costs down. When you are in a network your choices are, by definition, limited to preselected choices. If you want to see a doctor who practices outside of your PPO or HMO network then you will more than likely pay more for it.

To learn more about understanding managed care insurance limitations, be sure to consult with a health insurance expert. If you’re getting your managed care insurance through your employer, you can also discuss the nature of your managed care plan, whether it’s a PPO, HMO, POS or any other kind of plan with your human resources officer. He or she is trained to explain managed care insurance benefits to fellow employees.