HMO and PPO Insurance Plans

Understanding the type of medical insurance you have, or the kind you can enroll in for your family, is important. You want to be able to know that you and your family members will be covered when you need to see a doctor for anything from a routine checkup to a medical emergency. However, health insurance is not as simple as paying into a plan every month and seeing any professional you want when you want. It is also necessary to understand your plan so you know what services are covered when you visit a Costa Mesa urgent care center. Most Americans that have health insurance through their employer, and a good portion of those that pay out of pocket, have either an HMO or PPO plan. But what are these types of plans and how are they different?
Health Maintenance Organizations (HMOs)
An HMO plan is one that requires you to get most of your health care needs from a provider that is pre-approved as part of a larger network. You will need to choose your primary care physician, who will be your doctor and first point of contact within the organization. This means that if you or your family member needs to see a specialist, such as an orthopedist, you will need to first see your primary care physician in order to get a referral. Otherwise, you will have to pay out of pocket for services by going to a specialist that is not within the network.
Preferred Provider Organizations (PPOs)
A PPO insurance plan allows you to select a doctor from a preferred list put together by the provider. You do not need to select a primary care physician and can instead see anyone you need to within the PPO network. When you do need to go to the doctor for a checkup or any ailment, you are responsible for paying up to your annual deductible and copay. Like an HMO, if you choose to receive treatment from a facility that is not in the network, you must pay for services on your own.
What about Urgent Care?
When an accident happens, or you get sick unexpectedly, it can be difficult to get an immediate appointment with your usual doctor. As such, you need to make a decision between going to the emergency room or to an urgent care center for medical attention. As your Costa Mesa urgent care facility, we know that your first priority is getting better. That is why we work with HMO, PPO, and other insurance providers, in order to ensure that you only have to focus on your health.
The average cost of service at an urgent care center is much less than rushing to the emergency room, so knowing that your insurance plan covers some of your expenses makes the decision that much easier. You can learn more about the medical services that we offer, and the insurance providers that we have contracted with before visiting, so that you can be sure to get the medical help you need without delay. Call us today at (949) 548-8400 to get started.