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California Health Insurance Basics

The three major types of health care plans are HMOs (health maintenance organizations), PPOs (preferred provider organizations), and point-of-service (POS) plans.

These plans cover a majority of the medical expenses, and only charge a smaller amount to the insured. You may pay for treatment in advance, for the doctors visit and other diagnostic services rendered.

With these plans there are 2 types of doctors you can go to. Physicians inside their network, and outside their network. MDs outside the provider network have no agreement with the company to negotiating their fees, so their cost can't be contained or reduced. Doctors inside the network have agreed to keep their costs at a set rate, in exchange for becoming a member of the insurers network (with access to their patients), and timely payment.

Advantages to using your doctor inside the provider network:

  • Cost are held down
  • You pay a lower percentage of their negotiated fee
  • Paperwork is usually minimal
  • You know what you will owe ahead of time, in writing
  • Most services have a good portion covered by your provider

Advantages to using a doctor out of network:

  • You may have a lower doctors visit
  • You don't have to pay depend on an in network specialist for a referral
  • You usually get billed for work done
 


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