Currently have Blue Shield of California PPO (individual). Coverage is fine, premiums are absurd, and this year premiums are increasing by about $100/month. This leaves me feeling like I may need to switch to an HMO.
In the process of figuring out what I lose in an HMO to justify the more than $200 reduction in monthly premium, one obvious point is that they want to route more coverage through your PCP to limit unnecessary specialist fees.
But I was curious what causes doctors to not want to accept HMOs (because those in network with the HMO are far fewer than those I could see through the PPO). I heard that HMOs pay a flat rate per visit, while PPOs pay depending on what is done by the doctor. Is this the case?
Does this mean something like the HMO and PPO might pay the same amount for a consult, but the doctor will get no added compensation for performing a procedure at the appointment? Wouldn’t that disincentivize a doctor for providing more than the absoute minimal of care he/she can get away with?
I’m also wondering when it comes to therapists: Do HMOs and PPOs pay the same in that case? As far as I’m aware they are both on the same Magellan Health network and an hour of talking is an hour of talking one way or the other.
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