Appropriate Care

Appropriate Care

HMOs, PPOs, and fee-for-service plans often share certain features, including pre authorization, utilization review, and discharge planning.

For example, you may be asked to get authorization from your plan or insurer before admission to a hospital for certain types of surgery. Utilization review is the process by which a plan determines whether a specific medical or surgical service is appropriate and/or medically necessary. Discharge planning is an approach that facilitates the transfer of a patient to amore cost-effective facility if the patient no longer needs to stay in the hospital. For example, if, following surgery, you no longer need hospitalization but cannot be cared for at home, you may be transferred to a skilled nursing facility.

Almost all fee-for-service plans apply managed care techniques to contain costs and guarantee appropriate care; and an increasing number of managed care plans contain fee-for-service elements. While the distinctions among plans are growing increasingly blurred, the number of options available to consumers increases every day.

By |2011-10-14T14:54:43+00:00October 14th, 2011|Categories: Buyers Guide For Health Insurance|Tags: |0 Comments

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Jesse is the Founder and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. He is a licensed health and life insurance broker in 47 states and the District of Columbia. Jesse specializes in Medicare and health insurance benefits packages for businesses and their employees. Jesse is the designated responsible broker for Smedley Insurance Group, Inc. He founded Smedley Insurance Group after working for a small captive insurance agency where he was required to sell perhaps the worst health insurance plans to consumers because it was all the company had to offer. He knew there had to be a better way and thus, SIG was born. Jesse can be reached toll free at (866) 260-9829, Ext. 101. His email address is: his first name @iHealthBrokers.com.

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