What is point of service medical health insurance?
Reader question:
What is point of service medical health insurance?
Maggie
Great question.
A point of service medical health insurance program is kind of like a mix of both traditional indemnity insurance and health maintenance organization insurance. It has some of the qualities and cons of both, and while it has some of the flexibility of the traditional indemnity plan, it also contains the requirement of the HMO plan that you must pick a primary care provider and go only to them without a very good excuse. It’s like being both free yet organized if you pick a point of service medical health insurance plan.
If you have a point of service medical health insurance plan, then you have to choose your primary health care provider and hospital from a network chosen by the health insurance company. This isn’t a strict arrangement. If you go to a physician or hospital within the network, then you will be covered or have to make a co-payment in order to be treated for your sickness or injured part. But there is also the option of choosing a physician or hospital outside of the network to go to. If you do this, you must then file a claim with your POS.
The Good:
- Most of the point of service medical health insurance plan allow you to receive your health care outside of the network that they provide. This sounds nice and flexible at first, but it has its drawbacks. While you can get good coverage within the network, it drastically decreases once you move outside of it.
- Point of service health insurance plans are very good on things like preventive medicine and services. Not only are you covered for things like pap smears, but you even get things like cheaper rates for gyms and classes to help quit smoking.
The Bad:
- Like in an HMO, point of service medical health insurance plans require that you choose a primary health care provider, and you are then required to use that provider if you want the best rates.
- Yes, you are allowed to go outside of the network to see a doctor or specialist, but that doesn’t mean that it will be easy to get covered. If you do it without a referral from your primary health care provider, then you have to send in the bills all by yourself and might not get a check back at all, and if you do it will be a small one.
Cheers,
Fashun Guadarrama.