HMOs vs PPOs


As the owner of a new or growing medical practice, it’s important to have a strong understanding of your patient’s health insurance options. The vast majority of your patients will be enrolled in either an HMO or a PPO medical insurance plan. Understanding the differences between these two types of insurance will help you and your staff provide a better patient experience, develop relationships with insurance providers, and ensure you get paid for your services swiftly and accurately.

HMO insurance plans tend to be more restrictive than PPOs. Often you will only be able to accept a new patient if you are a part of their HMO network. If you are a specialist, a patient on an HMO plan may not be able to see you without a referral. HMOs tend to have low or no co-pays, low deductibles, and high patient satisfaction ratings.

PPOs are the more flexible, and more popular insurance choice for many patients. With a PPO, a patient is more likely to be covered for your services, even if you’re not in their network. While copays, deductibles, and out-of-network services tend to be higher with PPOs, many patients are willing to pay more for the flexibility of seeing the physician of their choice.

Most of the patients you see in your practice will be covered under HMOs, PPOs, and other types of medical insurance. Make sure you and your staff are familiar with insurance protocol so you know which patients you can accept, and so you can collect and process payments quickly and easily.

To learn more about doctor credentialing, insurance, coding, outsourcing, and everything you need to establish a successful healthcare practice, follow all of Sherlock Doc’s adventures on the or Doctors Business Channel on YouTube!.

Author: DBN