103. What are the characteristics of a managed care insurance plan?

HMOs and PPOs are managed care plans. Any plan that requires pre-approval for treatment, authorization for continued treatment, or limited access to health care providers is a managed care plan.

These plans are called managed care because:

  • The insurance company "manages" or oversees access to health care treatment, and controls the costs of treatment through this management process.
  • The company determines whether you require treatment based on their assessment of your problem.
  • The company controls access to providers, telling you who you can see for treatment.
  • The company controls what type of treatment you can receive, by limiting payment for authorized services only.
  • The company controls length of treatment and frequency of treatment appointments, by authorizing only those services it feels are necessary.

 

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