Point-of-Service (POS) Plans
Point of service plans or POSs are sometimes called
an ‘open ended HMO’ or an ‘open ended PPO’.
This is because point of service plans offer a network of hospitals
and doctors for their members to choose from as do HMOs and PPOs.
The difference, however, is that POSs allow for their members
to receive their health care services outside of the network,
though use of providers within the network is encouraged.
Based upon the usual health insurance provision
that medical costs may be offered at a lower rate in exchange
for limited choices in providers, POSs has several variances from
other plan types. For example, newly enrolled members of POSs
must pick a primary care doctor to keep tabs on their health.
This doctor becomes the new member’s point of service and
is chosen from the list of pre-approved doctors in the provider’s
health care network.
The POS doctor may refer the member to doctors not
included in the network. However, the entire claim will not be
covered as it would have been had procedures and appointments
been performed by an agency within the network.
To further encourage members to choose providers
from within the approved network, all paper work for doctor visits
within the network are completed for the member. For doctor visits
outside of the network, paper work is expected to be completed
by the member. Full documentation of bills and receipts are required.
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