subject: Point Of Service Health Insurance [print this page] Point of Service, or POS, health insurance plans are unique in that they combine the benefits of the HMO and PPO plans. However, along with all health insurance plans, there are both pros and cons to point of service plans.
A point of service health insurance plan is based in the foundation of the HMO plan, where lower medical costs are offered for a more limited selection of providers. However, the different between these two types of insurance is that if a referral is made to an out-of-network provider, there still is some coverage, whereas in an HMO, coverage is only offered in-network.
Also similar to an HMO, primary service health insurance policies require the selection of a primary care physician to monitor and help coordinate all aspects of your health care. This individual must be chosen within the network, and becomes your "point of service." The primary care physician must make referrals for any care outside the network to be covered, and coverage is always lower out-of-network.
If an out-of-network provider is chosen by a client for a particular service, it is then the responsibility of the patient to complete all paperwork, including filling out forms, mailing in bills, and keeping accurate health care records. This is all taken care of by the service provider for any in-network care.
One of the benefits for the POS health insurance policy is that in-network co-pays are quite low, and there is no deductible that must be met every year for in-network services. In addition, if you opt for an out-of-network provider, you still have some level of coverage to help offset out-of-pocket expenses.
However, there is a deductible for non-network care that must be met before any coverage is offered. Following the fulfillment of this deductible, co-pays are still high, and you will often have to pay the difference between the provider's billed amount and what the insurer considers to be "reasonable and customary" for any particular service.
In addition, as with and HMO health insurance policy, the primary care physician must first approve and refer a patient for any specialists or procedures in order for coverage to be in effect. Some of the problems with this is that no general practitioner knows everything about every medical problem, so many of these decisions should instead be made by a specialist instead in order to ensure the highest level of care.
Point of service plans, as with all types of insurance plans, certainly have their problems, but are astronomically better than going without health insurance at all. Reviewing the available options and comparing them to your family's needs is the best decision you or anyone else can make when it comes to choosing between a point of service plan and any other health insurance options.
by: Casey Trillbar
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