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Managed Care, HMO Insurance
Health Insurance Coverage Information & Updates, October, 2001:
- Benefit and coverage rules and policies differ from carrier to carrier AND plan to plan, therefore it is imperative that subscribers familiarize themselves with the specifics of the plan.
- Examples of rules and policies include:
- Choosing a Primary Care Provider (PCP) to manage the subscriber's healthcare needs and related issues.
- Understanding the PCP?s role in coordinating the various aspects related to the subscriber's health-related needs.
- Obtaining the appropriate authorizations and/or referrals if the requested service(s) require such actions and documentation. Likewise, subscribers must familiarize themselves with coverage exclusions.
- Many Managed Care or HMO carriers have co-payment or deductible requirements for some or all types of healthcare services.
- NewYork-Presbyterian Healthcare System strongly recommends all patients read, question and ultimately understand the provisions and policies with respect to healthcare coverage to reduce or eliminate financial penalties imposed by the insurance carriers for non-compliance of insurance plan rules and policies.
- If you are enrolled in a Managed Care or HMO plan through an employer, your Human Resources Department should be a source of information and assistance with respect to your individual benefits.
