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In U.S. health insurance, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at ...
In the United States, an exclusive provider organization (EPO) is a hybrid health insurance plan in which a primary care provider is not necessary, but health care providers must be seen within a predetermined network. Out-of-network care is not provided, and visits require pre-authorization.
Five factors that can be used to assess the advancement level of a particular IDN include provider alignment, continuum of care, regional presence, clinical integration, and reimbursement. [5] Between 2013 and 2017, healthcare providers created 11 new integrated delivery systems from joint ventures with insurance companies. [6]
An HMO — or health maintenance organization — is a healthcare plan that offers care within a network of approved medical providers, including doctors and hospitals.
A survey issued in 2009 by America's Health Insurance Plans found that patients going to out-of-network providers are sometimes charged extremely high fees. [ 117 ] [ 118 ] Network-based plans may be either closed or open.
Blue Cross and Blue Shield insurance companies are licensees, independent of the association and traditionally of each other, [16] offering insurance plans within defined regions under one or both of the association's brands. Blue Cross Blue Shield insurers offer some form of health insurance coverage in every U.S. state.
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