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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.
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.
Many managed care programs are based on a panel or network of contracted health care providers. Such programs typically include: A set of selected providers that furnish a comprehensive array of health care services to enrollees; Explicit standards for selecting providers; Formal utilization review and quality improvement programs;
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]
In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. [1] It is an organization that provides or arranges managed care for health insurance , self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health care ...
Hospital networks in the United States (31 C, 213 P) Medical outsourcing companies of the United States ... Health insurance companies of the United States (4 C, 30 P) *
Ghost network refers to a form of healthcare insurance fraud where providers are listed as in a health insurance plan, but are unable to provide care. These ghost providers may no longer be eligible to practice, may have retired, may no longer accept new patients, may not actually part of the network, or may not exist.
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