Managed care is a big part of health care today. The main question is whether it is the best way to control health care costs. Becausesometimes managed health care can be advantageous or other times it may be disadvantages. We will look at both the advantages and disadvantages of managed health care.
MANAGED HEALTH CARE
Most people who have managed care health insurance don’t even understand the concept or why they might be better or worse than ordinary insurance plans.
In managed health care insurance, mainly companies attempt to control the cost of health care for employers by introducing specific guidelines or protocols health care professionals must follow and improve the ways both employees and employers select their medical providers and facilities.
The assumption is the plan will allow a financial accounting that shows the results of various medical treatments in both patient responses and quality of life issues.
TYPES OF MANAGED CARE PLANS
Currently there are three different types of managed health care plans are available.
They are as follows:
- Heal Maintenance Organizations (HMO)
- Preferred Provider Organizations (PPO)
- And Point of Service plans (POS)
Each is a little different from the other. The main features of these plans are to provide the same basic service i.e. managed health care.
benefits OF MANAGED CARE
- Lower Cost
- The first and main advantage of managed healthcareis the lower costs associated with them.
- The aim of managedhealth care is to keep healthcare costs down without sacrificing quality.
- This is a great benefit of these types of health care plans.
- This is accomplished through the contracts that are set up with doctors and hospitals.
- Another advantage seen by many in managedcareis the network of health care providers that are readily available to them.
- All the doctors and health care providers that are contracted through managed health care plans have to pass a very in depth accreditation process in order to be approved for their network of care providers.
- This is important to members in that it gives them peace of mind to know that they are in good hands
- Along with the initial visits, medications are also covered underneath these plans.
- For many, this is the main reason for appeal to these managed care plans.
- This greatly reduces the cost of already expensive medications.
- Some people need medications in order to live a healthy life, and many of these medications are ridiculously high priced.
DISADVANTAGES OF MANAGEDCARE
- Restricted Care
- Since you can only visit doctors that are in your managed health care provider’s network.
- So your options get limited, as to who you can see.
- Many doctors are instantly out of your reach with these plans.
- Strict Approval
- Insurance companies are businesses, meaning their primary goal is to make a profit.
- Because of this, the things that they are willing to fully cover, or cover at all, are very strict.
- Pre-approval is required before starting treatment.
- You must tell an insurance company representative about your problem to be approved, no matter how embarrassed you are to talk about it.
- You may have to wait weeks for an appointment.
- You must receive authorization for all treatment.
- Many people with preexisting health conditions and problems are out of luck.
- It is not uncommon for a doctor to refer you a specialist when a problem is out of his scope of practice.
- They do not concern themselves with finding out if that doctor is in your care network, meaning you cannot go to see them, and if you do the cost will come fully out of pocket.
- While many people criticize the quality of care and the ethical practice of managed care providers, the fact remains, they provide a great service to many people.
- Without health insurance even the most minor of illnesses can cause an incredible amount of financial stress.