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trolled if patient care is delivered within the confines of a more closely monitored system. Patients are required to use health care providers who are approved by their plan. The approved providers have agreed to offer the care at a discounted rate for members of that plan. Patients typically are penalized financially for receiving health care outside the network of approved providers.
The two main types of managed care plans are the Preferred Provider Organization (PPO) and the Health Maintenance Organization (IIMO). ,
PPOs typically utilize the services of a limited number of private physicians and other providers who agree to offer their services to the plan at a discount price. Patients have their choice of the approved physicians, and usually must satisfy a deductible and co-payment. Patients have much higher out-of- pocket expenses if they seek care outside the network of preferred providers.
HMOs often hire their own physicians, and also employ nurses, nurse practitioners and physician assistants who can provide care less expensively to patients who are not seriously ill. There usually are no deductibles with an MMO plan. The patient pays a low per-visit charge, usually around $10.
All managed care plans have at least one thing in common. They are heavily primarycare driven. Patients usually cannot see a specialist until they have seen a primary care physician first. Primary care physicians usually are generalists rather than specialists. Since they are less expensive than specialists, managed care plans try to insist that patients see them first. If their problem requires a specialist, the primary care physician makes a referral, allowing the patient to
See HMO, Page 14
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