Insurance Quotes

If you want affordable health insurance quotes, there are time-tested tips you can implement. As you read through this write-up you’ll see practical steps you can take to save much in health insurance. Some of them are things that you can undertake in minutes: others have to do with making certain adjustments. However, the good thing about them all is that you can take action on them.
1) Make positive changes in your lifestyle. There are lifestyles that will make it hard for you to get affordable health insurance…
Obese people are more likely to suffer a good number of health conditions. Insurers know that smokers are very high risks in health insurance and therefore charge them much higher premium. Smokers and other tobacco users are more susceptible to many diseases.
If you can make the sacrifice required to change to a more positive lifestyle (yes, you can), you’ll not only live a healthier life but will also get more affordable health insurance rates.
2) If you can, ask for higher deductibles but don’t go overboard with it. You’ll be expected to pay it first before your insurer will make out any payment. A Higher deductible will result in more affordable health insurance quotes. Remember, to consider something high enough but within easy reach.
3) You can easily get too much health insurance just as you can get inadequate insurance. If you fall among the former, you can get the right insurance plan for you and use the excess on something else.
There are people who hardly ever fall sick. In such a case, it will make perfect sense to leave more expensive plans and opt for more affordable health insurance plans like catastrophic health insurance. They’ll be covered if they fall sick suddenly or have injuries that demand medical attention. However, they’ll pay a lot less in premium (Which, I guess, is what you want too).
If you want to make get affordable health insurance quotes within the next 15 minutes, take out some time to visit at least three insurance quotes sites. Obtain and compare the quotes you get after giving your correct profile.
Here are my favorite pages for health insurance quotes…
InsureMe Health Insurance Quotes
Health Insurance Quotes
Publishers can get unique versions of my articles by following any of the links above. Click on “To Use My Articles” when you get to my site.
Chimezirim Odimba writes on insurance.

Article Source: http://EzineArticles.com/?expert=Chimezirim_Chinecherem_Odimba

Since 2001, major health insurance providers have been allowing consumers to buy policies online. Through the convenience of the internet, consumers are able to compare prices and coverage to find the best insurance policy for them. Before you sign up with a health insurance provider, you should consider price, company history, and coverage to make sure you find a good plan for your situation.
Identify Your Coverage Needs
Before you start gathering quotes for health insurance policies, identify how much coverage you will need. Start by looking over your past medical expenses for the last three years. Do you need a lot of coverage or do you rarely need to see a doctor?
Next, consider your future expected medical expenses. Are you looking to cover typical office visits through the year? Or do you want to protect yourself from a medical catastrophe? Based on these answers, pick the coverage plan that will meet your needs.
Compare Costs
If you want to make sure you are getting the best deal on health insurance, compare prices. Online insurance websites make this process easy. You enter your basic information online, and then get several quotes from different health insurance companies.
Check The Coverage
Before you sign up with a health insurance provider, check the coverage that is being offered. Compare deductibles and co-pays, covered procedures, and hospital visits amongst offered policies. The more coverage provided, the higher the premiums. But this could save you more money in the long run, so in your decision also factor in how much you will use medical services.
Find A Doctor
There are two types of insurance plans – those that allow you to see any doctor and those that require you to use approved network doctors. Be sure to check that the doctor you want to see for typical office visits is covered by your plan. Managed plans that require you to see a network doctor usually have several doctors to choose from in populated areas.
Research The Company
Once you have quotes from a couple of health insurance providers, take the time to research the company to make sure you are comfortable with them. Check to see how you can contact them if you have a problem and their financial records. You can do all this online.
To view our list of recommended companies online that provide health
nsurance and can help you compare quotes, visit this page: Recommended Insurance Companies Online.
Carrie Reeder is the owner of eZerk, an informational website with articles and information about various topics.

Article Source: http://EzineArticles.com/?expert=Carrie_Reeder

What is a Health Maintenance Organization?

Health Maintenance Organizations (HMOs) are only one of many types of managed care arrangements. However, it is one of the oldest forms of managed care. Some describe it as “pure” managed care. If the different types of managed care were placed along a continuum, Managed indemnity plans, which are very similar to conventional insurance, would be at one end.

At the other end would be HMO’s. As one moves toward the HMO end of the continuum, the organizations become more complex and have higher operating costs. However, more emphasis is placed on prevention and quality of care. There is also more opportunity to control health care costs in HMOs than in indemnity plans.

Individuals who join an HMO are considered members. Typically HMOs provide members with comprehensive health care. When someone joins an HMO, they select a primary care physician from the list provided by the HMO. That primary care physician coordinates all of that member’s medical care.

If care by a specialist is needed, the primary care physician will refer the member to a specialist who is usually also in the HMO network. In an HMO, physicians may be employees of the HMO or the HMO may contract with independent physicians to provide care. Members who go outside of the network to receive care (unless given prior approval) will probably pay all or most of the cost of that care out of their own pockets.

HMOs use a “capitated” financing system. Care is provided to each member of the plan for a fixed amount. Typically, an employer contracts with an HMO to provide care for its employees and pays this fixed charge. If you are part of a Medicare HMO, then Medicare pays the fee.

Some HMOs also charge individuals a small $5 to $10 co-payment for each visit. If the HMO is efficient and keeps its members healthy, it will make a profit. If it has too many members who require costly sick care, its profits are smaller or it may lose money. Remember under a “capitated system”, the HMO is paid a fixed amount per person rather than for each visit or by type of service.

To compensate this huge loss people need to get the insurances. People are not only insuring their belongings but also they are insuring their health under best health plans so that they can meet the medical expenditure. The experts have always suggested people to take the insurance quotes before insuring their health. If a person wants to insure any other belongings then also he should take the insurance quotes.
The insurance quotes of all the companies are not same and one needs to compare several quotes before taking a policy. A person should make insurance with the affiliate network of health care. One can search the internet to know about the quotes of the health insurance. Generally, people try to get the free insurance quotes as it is not wise to invest money for getting the quotes. To get the insurance quotes from the internet one needs to provide some personal information to the sites. The companies would provide the quotes depending on the information provided to them.
One should know that there are several health insurance companies working in the market and all of them do not provide the same facilities to the people. A person is suggested to compare the facilities offered by these companies. It is advisable to take the insurance of the company that provides maximum facilities. In most of the cases people try to get the insurance plan that cover maximum number of diseases and their treatment. The aarp health insurance plans cover the medical expenditure if an insured person needs treatment after accident. There are many other plans which cover accidents under their policy.
A person who wants to insure his health with any insurance company should check the financial rating of the companies which are offering health insurances. One should have an insurance with the company that has the highest rating. The financial strength of a company is very important and one should consider it while investing money. A company that is not financially strong is not capable to pay the claims of the people. The ratings of the aarp health plans are quite better than many other plans available in the market and one can take these plans.
One can know the financial ratings of the insurance companies by searching the internet. To get maximum benefit a person should check the background of doctors who are related to the health insurance company. A person should insure with the company that has reputed doctors. One needs to decide whether he needs an insurance plan for group or individual. The insurance quotes for groups and individuals are not same. A person can get the best insurance plan if he knows these basic steps.

By: Natasha Natasha
Article Directory: http://www.articledashboard.com

When you’re in the market for health insurance, you can’t go wrong when go to an insurance comparison website to look for instant online health insurance quotes. There you’ll find affordable rates for individual health insurance, and the service is free for you to use.
The Benefits of Online Health Insurance
The main reason people are uninsured is because they can’t afford health insurance. If your employer doesn’t offer an affordable insurance policy, your only other option may be to search for individual coverage.
Going online to find this coverage can save you both time and money:
* You’ll save time because you won’t have to call or visit multiple insurance agencies and listen to their sales pitch while you fill out forms with the same information over and over again. Instead, you’ll fill out one simple form on your computer at your convenience.
* You’ll save money because you’ll be able to compare multiple quotes and choose the one that’s the most affordable. Did you know that health insurance premiums can vary by hundreds of dollars from one company to another? Going online lets you choose the cheapest plan.
Going online for health insurance doesn’t mean you give up the benefit of having an insurance professional on hand to help you out. The best insurance comparison websites offer a chat feature so you can get fast answers to your insurance questions from an insurance expert.
What Types of Health Insurance Are Available Online?
Instant online health insurance quotes are available for all types of insurance plans online, including:
* Traditional indemnity plans
* Managed care PPO and HMO plans
* Long-term or short-term plans
* Major medical plans
* High-deductible plans
* Medical Savings accounts
* Special illness plans
* Supplemental insurance plans
Whatever your insurance needs, you can find an affordable online plan.
Where to Get the Best Rates

By: Brian Stevens
Article Directory: http://www.articledashboard.com

Insurance Quotes A to Z’s Managed Care: Abbreviations and Key Terms

Balance Billing - The practice of a provider billing a patient for all charges not paid for by the insurance plan. Balance billing is generally prohibited by managed care plans.

Capitation - The insurer pays health providers a set amount for each person enrolled in the managed care plan rather than for the number and type of services delivered. The amount paid may vary by factors such as age and sex of the enrolled member.

Closed panel – A managed care plan that contracts with physicians on an exclusive basis for services and does not allow those physicians to see patients for another managed care organization.

Coinsurance – Under conventional insurance plans, there is often a limit on the amount covered by the plan, commonly 80% of UCR charges. Any additional costs are paid by the member out of pocket.

Copayment – That portion of a claim or medical expense that a member of a health plan must pay out of pocket. Usually this is a fixed amount, $5 or $10, for each visit.

Credentialing – The process of obtaining and reviewing the documentation (licensure, certifications, insurance, etc.) of health professionals. Generally, this includes reviewing information given by the provider and verifying that the information is correct and complete.

Deductible – That portion of an individual’s health care expenses that must be paid out of pocket before insurance coverage applies. A common deductible is $200. Deductibles are used in insurance plans and PPOs, but usually not in HMOs.

Fee-for-service – The traditional method of reimbursing physicians, hospitals and other health care providers for their services. Providers are paid each visit. The fees increase as more services are provided or as more expensive services are substituted for less expensive ones.

Formulary - A listing of drugs that a physician may prescribe. The physician is requested or required to use only formulary drugs unless there is a valid medical reason to use a nonformulary drug.

Gatekeeper - A primary care physician (PCP) in a managed-care plan who is responsible for monitoring a patient’s care and deciding when specialized care or tests are needed. Except in actual emergencies, all care from providers other than the member’s PCP must be authorized by the gatekeeper.

Group model - An HMO that contracts with a medical group for the provision of health care services. The relationship between the HMO and the medical group is generally very close, although there are wide variations in the independence of the group from the HMO.

Managed-care – A general term for any system of health care delivery organized to improve cost effectiveness. It includes arrangements with doctors and hospitals to supply health care services to members for a set fee, criteria for the selection of health care providers, significant financial incentives for members to use providers in the plan and formal programs to monitor the amount of care and quality of services.

Midlevel Practitioner (MLP) – Nonphysicians who deliver medical care, generally under the supervision of a physician. Some examples of MLPs are physician’s assistants, clinical nurse practitioners and nurse midwives.

Network - A selected group of physicians, hospitals, laboratories, and other health care providers who participate in a managed-care plan’s health delivery program. Providers agree to follow the plan’s procedures, permit the monitoring of their practices and provide certain negotiated discounts in exchange for a guaranteed patient pool.

Open panel - A managed care plan that contracts with private physicians to deliver care in their own offices.

Primary Care Physician (PCP) - The term usually applies to internists, pediatricians, family physicians, and general practitioners. It may also apply to obstetrician/gynecologists.

Point Of Service (POS) - Generally, the plan enrolls each member in both an HMO (or HMO-like) system and a conventional insurance plan. Members do not have to choose how they will receive services until they need them. The amount the member is reimbursed depends on whether the member chooses to use the plan or go outside the plan for services.

Service plan – A health insurance plan that has direct contracts with providers but is not necessarily a managed care plan. Providers bill the plan directly rather than billing of the member and are paid directly by the plan.

Staff model – AN HMO that employs providers directly. These providers see members at the HMO’s own facilities.

Usual, Customary, or Reasonable Fees (UCR) – A method of reimbursing providers on the basis of a profile of prevailing fees in an area. One common method is to average all fees and then pay providers 80% or 90% of that average amount.

Utilization Review (UR) – A general term for an insurance or managed care plan’s review of the health care provided to its members. This includes such activities as granting prior approval before hospitalization or doing certain procedures; coordinating a patient’s care and rehabilitation once they have left the hospital; and making decisions about whether a second opinion is necessary .

Rising health care costs over the last 30 years resulted in a call for health care reform. While legislative reforms failed, “market-driven” reform is occurring. As a response to growing concerns expressed by businesses and by the Federal and state governments, the health care industry is reorganizing itself in an effort to control costs. Managed care is the result.

What is Managed Care?

Managed Care is a system of health care that controls cost of services, manages the use of services, and measures the performance of health care providers. There are different types of managed care plans. Two of the most common types are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). Most others are hybrids of the two. Since plans are different, it is important for individuals to know the details of their specific plan.

Managed care is both a health care financing and a health care delivery system. Plans typically guarantee 24-hour, seven-day-a-week access to health care for its members. Under most plans, a primary care physician coordinates all care for a patient. When specialists are needed, the primary care provider makes a referral. The plan member selects a primary care physician from a list provided by the plan.

How Does Managed Care Differ from Conventional Insurance?

Historically, this country’s health care industry was made up of a large number of independent health care providers who owned their own practices. These were either solo practices or practices jointly owned by physicians who practiced together in a clinic setting. Furthermore, almost all communities of any size had their own hospital, most of which were independent from one another. Frequently these facilities were run as nonprofit institutions.

Under managed care, physicians, hospitals, and other health care providers are linked contractually into networks. These providers agreed to provide care to members (patients) at fees established by the network. Network providers also agree to abide by other cost control and practice guidelines set by the network. In general, managed care differs from conventional health insurance in some of the following ways.

Choosing a Doctor

Conventional insurance – Individuals can choose any physician they want at any time they want. This includes choosing a specialist of their choice.

Managed care – Individuals choose a physician from a list provided by the plan. When using specialists, different plans have different requirements. In some plans, members can select any specialist from the list provided by the plan. In others, the individual’s primary care physician must make a referral.

Deciding about the quality of care

Conventional insurance – The individual is responsible for determining if her physician is qualified to provide the kind of care that was needed. The individual is also the one to determine if she is receiving quality health care. The health insurance plan usually does not get involved in this decision.

Managed care – The plan typically determines if a doctor is qualified before the doctor joins the managed care network. Annual surveys of patients and chart reviews are also done to maintain the quality of care. Some plans also have a grievance procedure which members are encouraged to use if they are not satisfied with the quality of the care.

Paying for Care

Conventional insurance – The usual method of payment is called fee-for-service. The physician is paid for each appointment. The bill increases as more services are provided, or as more expensive services are substituted for less expensive ones. Typically, the individual pays the bill and is partially reimbursed by their insurance company.

Managed care – The usual method of payment is known as “capitation”. Providers are paid a fixed amount for each person (member) enrolled in the plan. Whether the member never sees the doctor or sees her 20 times, the provider does not get any more money than the agreed upon amount. The capitated (fixed) amount is usually paid by the employer or Medicare. Some plans also have members pay a small co-payment for each visit.

It is also worth noting that under managed care, individuals are being encouraged to assume more responsibility for their own health. At a minimum, this means taking a more active role in the health care decision making. However, some plans also emphasize greater responsibility for lifestyle decisions.

How Does Managed Care Control Costs?

The most obvious strategy for controlling costs is by contracting with providers to provide care for members at reduced rates. Another approach has been to spread the financial risk of providing care to providers.

Under a capitated system, the provider assumes some of the financial risk for providing care. As a result, they have a vested interest in keeping members healthy and controlling access to more expensive tests and procedures. The associated risk to the consumer is that too few services will be provided. To ensure the quality of care, members should become familar with their plan’s grievance procedures and use them when necessary.

Managed care plans also control costs by setting criteria for selecting providers and by establishing formal programs to monitor the amount and quality of care being given. Utilization review is one common monitoring strategy. Except for emergencies, doctors are often required to get approval from the plan before hospitalizing a patient or before providing expensive tests and procedures.

Are There Concerns About Managed Care?

Much less is known about other managed care models, but research shows that HMOs are achieving cost savings. While this is one advantage to managed health care, critics point to disadvantages. Managed care might result in too few services being provided. Most plans restrict a patient’s “free choice” of providers. Managed care does not address the issue of access to health care services for those without insurance, or for those living in rural communities where managed care may not be economically feasible.

In the future, all of us will be expected to assume more responsibility for our own health. In part that involves learning about the plans that are offered and using the selected plan appropriately.

References:

• Cordes, Sam, Ph.D. 1995. Hogs and Health Care: There are Similarities. Corn Husker Economics (May 31). Lincoln, NE: University of Nebraska, Cooperative Extension.
• Lipman, Marvin M., M.D., How to Manage with Managed Care, Consumer Reports on Health. September, 1994. Yonkers, NY.
• MacLeod, Gordon K. 1993. An Overview of Managed Health Care. In The Managed Health Care Handbook edited by Peter R. Kongstvedt, MD. Gaithersburg, Maryland: Aspen Publications, Inc.
• Mueller, Kurt, Ph.D.; Andrew Coburn, Ph.D.; Robert Crittenden, M.D.; Sam Cordes, Ph.D.; J. Patrick Hart, Ph.D.; and Wayne Myers, M.D. 1996. Changes in the Health Care Marketplace: What is the Future for Rural Health Care Delivery? A National Key Informant Survey. Prepared by The Rural Policy Research Institute Expert Panel on Rural Health Delivery. Columbia, Missouri: University of Missouri.

What is a Gate Keeper?

Many types of managed care plans use primary care physicians as gate keepers to control costs and coordinate health care services for their members. When individuals join a plan, they are provided a list of physicians who are part of the managed care network. Members are expected to select one of the primary care doctors on the list.

Before making a final selection, find out if the doctor is accepting new patients from your managed care plan. Some limit the number of managed care patients they will accept. Besides it is a good idea to interview the doctor in order to find out if this is someone you can work with. A primary care provider is usually a family practitioner or a general internist. For a woman, it might be a gynecologist. For younger patients, a pediatrician or family practitioner usually handles routine care.

Under some managed care plans, the member is expected to contact their primary care provider before receiving any health care. This is where the term gate keeper comes from. Many plans require that the individual’s primary care doctor make a formal referral to a specialist. If the individual makes an appointment for a specialist without the referral, he may be responsible for all or most of the specialist’s bill.

There are some advantages to having a primary care provider. It is estimated that 90% of an individual’s medical needs can be met by a primary care physician in the office. Since primary care doctors typically charge less, the cost of health care is reduced. Under ideal conditions, the primary care provider functions much like the traditional family doctor. He focuses on the health of the whole person rather than on a single organ system in the body. He emphasizes the importance of prevention and establishes a schedule for age-appropriate health screening.

When a suspected problem does exist, he can make the initial diagnosis, advise the patient on further treatment and make necessary referrals. The fact that all medical records are kept in one location also contributes to care that is better coordinated.

One concern about this approach is that too few services will be provided. In order to control costs the “gate keeper” may limit access to specialists or more costly tests and procedures. However, most plans (at least HMOs) are required to have a formal grievance procedure. To insure the quality of their care, members should become familiar with their plan’s grievance procedure, and be assertive about using such procedures when they believe the quality of their care is inadequate. There is another safeguard. Doctors know that poorer health outcomes and higher costs can result when care is not adequate or delayed. Therefore, whether practicing in managed care networks or under conventional insurance plans, good doctors are likely to continue to provide quality care in a timely manner.

Insurance Quotes: Most Americans are confused about the difference between Medicare, Medicaid and Medigap. Medicare and Medicaid programs are government programs created as part of the Social Security Act of 1965. Medigap is an insurance policy offered by private insurance companies to fill the “gaps” in coverage for Original Medicare. Here is a brief summary of the three programs.

Medicaid

Medicaid is a health insurance program financed and run jointly by the federal and state governments for low-income people of all ages who do not have the money or insurance to pay for health care. The goal of the program is to provide medical and other health care services to eligible individuals so that they are able to remain as self-sufficient as possible. Medicaid is a state administered program. Each state sets its own guidelines, subject to federal rules and guidelines. Certain services must be covered by the states in order to receive federal funds. Other services are optional and are elected by states.

Services that are often provided are:

• health screening and services for children,
• hospital and physician services,
• laboratory services and X-rays,
• care in nursing homes or
• home health care services.

Medicaid eligibility in nearly every state is limited to:

• low-income children,
• pregnant women,
• families with dependent children,
• persons who are blind or disabled, and
• persons 65 or older.

Other eligibility requirements must also be met.

Medicare

Medicare is a federally funded and administered program that provides health insurance for older Americans and those who are disabled. Individuals contribute to Medicare during their working years, just as they do to Social Security. Since Medicare is a federal program, eligibility guidelines and services are much the same all over the country.

People eligible for the program include:

• most persons over the age of 65,
• persons with disability status, or
• persons with irreversible kidney failure.

There are a number of Medicare plan choices. Two of the most widely available plans are Original Medicare and Medicare Advantage.

Original Medicare Plan

The Original Medicare Plan is available nationwide and is a pay-per-visit health plan. You can go to any health care provider who accepts Medicare and is accepting new Medicare patients. There are usually coverage “gaps” or costs that you must pay, such as deductibles, copayments and coinsurance. Some people buy a Medigap policy to cover these gaps in coverage (see Medigap below).

The Original Medicare Plan has two parts. Part A provides hospital insurance and Part B, which is optional, provides medical insurance. If someone chooses Part B, a monthly premium is deducted from his or her Social Security benefits. Insurance coverage for prescription drugs is a new benefit added on January 1, 2006. Insurance companies and other private companies work with Medicare to offer the drug benefit. Costs vary depending on which plan is selected by the individual.

Medicare Advantage Plan

Medicare Advantage Plans are available in some parts of the country. These are managed care Medicare plans. Medicare pays a set amount of money for your care every month to these private health plans whether or not you use services. In most of these plans, generally there are extra benefits and lower co-payments than in the Original Medicare Plan.

However, you may have to see doctors that belong to the plan or go to certain hospitals to get services. If you enroll in a Medicare Advantage Plan, you probably won’t need a Medigap policy because Medicare Advantage Plans usually provide a wider range of services.

Medicare does not cover all health care services, nor does it pay the entire cost of all the services that it does cover.

Medigap

Medigap insurance is also known as Medicare supplement insurance. A Medigap policy provides reimbursement for the out-of-pocket costs that are not covered by Original Medicare. Gaps in the Original Medicare Plan consist of deductibles, coinsurance and co-payments that the individual is responsible for paying. Medigap policies are sold by private health insurance companies. There are 12 standardized policies, called Plans “A” through “L.” Each plan has a different set of benefits. Not all companies sell all 12 policies.

hen purchasing Medigap insurance, shop around. Policies offering the same benefits can vary greatly in price. Since the plans are standardized they are easy to compare across companies. In addition, you want a policy that truly supplements Medicare — one that will cover that portion of the bill not covered by Medicare, as well as covering some additional health services not provided by Medicare. Also consider your own situation; not everyone needs a Medigap policy. For example, you might not need a Medigap policy if you have a Medicare Advantage Plan or a supplemental health insurance plan through your former employer.

While much has remained constant in Medicare and Medicaid since these programs were created 40 years ago, both programs have also changed a great deal. Faced with an aging population, rising health care costs and decreasing availability of employer-sponsored health insurance, governments are debating how to maintain these programs and control costs. In spite of these concerns, Medicaid and Medicare play a major role in providing health care coverage for people of all ages. Medigap policies can further reduce health care costs for individuals who have Original Medicare. For more information about Medicare, Medicaid and Medigap contact the Centers for Medicare and Medicaid Services at 877-267-2323 or visit the Centers’ Web site http://www.cms.hhs.gov/ Another good reference is the official Medicare Web site: http://www.medicare.gov/default.asp.

Source: Centers for Medicare and Medicaid Services http://www.cms.hhs.gov/

While legislative health reform seems to be progressing slowly, the health care industry is rapidly reorganizing itself in an effort to control costs. Managed care is the result. Managed Care is a system of health care that controls the cost of services, manages the use of services and measures performance of health care providers. There are different types of managed care plans. Therefore, it is important for individuals to know the details of their specific plan. In general, managed care differs from conventional health insurance in some of the following ways.

Insurance: Choosing a Doctor

Conventional insurance – individuals can choose any physician they want at any time they want. This includes choosing a specialist of their choice.

Managed care – individuals choose a physician from a list provided by the plan. When using specialists some plans allow members to select any specialist from the provided list. In others, the individual’s primary care physician must make a referral.

Insurance: Deciding about the quality of care

Conventional insurance – the individual is responsible for determining if her physician is qualified to provide the kind of care that is needed. The individual is also the one to determine if she is receiving quality health care. The health insurance plan usually does not get involved in this decision.

Managed care – the plan typically determines if a doctor is qualified before the doctor joins the managed care network. Annual surveys of patients and chart reviews are done to maintain the quality of care. Some plans also have a grievance procedure which members are encouraged to use if they are not satisfied with the quality of the care.

Insurance: Paying for Care

Conventional insurance – the usual method of payment is called fee-for-service. The physician is paid for each appointment. The bill increases as more services are provided, or as more expensive services are substituted for less expensive ones. Typically, the individual pays the bill and is partially reimbursed by their insurance company.

Managed care – the usual method of payment is known as “capitation”. Providers are paid a fixed amount for each person (member) enrolled in the plan. For example, the plan might agree to provide care for $100 per member per month. Whether a member never sees the doctor or sees her 20 times, the provider does not get any more (or any less) than the agreed upon amount. The capitated (fixed) amount is usually paid by the employer or Medicare. Some plans also have members pay a small co-payment for each visit.