Sunday, 13 December 2015

Managed Healthcare Services in Tampa, Florida, USA

USA's healthcare changing quickly. 25 years ago, Americans could meet doctor and insurance company and patient would share the cost. But now, more than half of people in US have managed care plans (a type of health insurance and organized way of both providing services & paying for them). It have agreements with medical facilities (doctors, hospitals etc) and healthcare providers (pharmacies, labs, x-ray centers, medical equipment vendors etc.) to give care to managed care plan members at lowest cost. Managed Healthcare is a health care delivery system designed to manage cost, utilization, & quality.
Benefits of Managed Care :
  • HMO cost is less than other insurance plans.
  • Educate members on plan benefits & how to access the appropriate level of care.
  • Helps members to live healthier.

There are mainly 3 types of managed care plans.
  1. Health Maintenance Organization (HMO)
  2. Preferred Provider Organization (PPO)
  3.  Health Maintenance Organization (HMO)Point of Service (POS)
Health Maintenance Organization (HMO) :
On a prepaid monthly fee basis, HMO offer many health benefits like treatments, diagnosis, tests, preventive care, surgery, hospitalization, etc. You will get services within the HMO network. After joining in a HMO, you need to choose a primary care doctor. The primary care doctor will provide your general medical care and if required he/she will refer you to a specialist. Due to this system, HMO cost is less than other insurance plans.
Preferred Provider Organization (PPO)
PPO managed care is like a fee-for-service situation. To become a member of PPO network, healthcare providers should offer medical services at lowest rates. There have contracts with a network of "preferred" providers. Members of the plan can refer themselves to other specialists. If you get service from a doctor in the preferred network you will only be responsible for your annual deductible and a copayment for your visit. If you receive care outside the preferred network, you need to pay a higher amount to the doctor directly & file a claim with the PPO to get reimbursed. 
Point of Service (POS) :
It is the combination of HMO and PPO. Like an HMO, you choose a primary care physician who is responsible for all referrals within the POS network. Members can refer themselves to other HMO networks and get plan coverage. If the primary care doctor refer you to other specialists, most of the bill or full bill will pay by this plan. If you refer yourself, like PPo you will have to pay some percentage of the bill.
Managed Care Organizations (MCOs) try to achieve their goals by controlling patient access to specialized care and eliminating unnecessary services; integrating health care delivery and payment systems through prepaid member fees; limiting provider fees by establishing fixed rates for doctors and hospital services; and controlling drug costs by implementing pharmacy benefits management plans. American Healthcare Technologies (AHT) is one of the best managed care organization in USA.
Key tasks undertaken by AHT :
  • Storing Member Details
  • Funding reconciliation
  • Claim Analysis
  • Auditing
  • Lab & Pharmacy Information

For more information go to the website :


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