I keep hearing about “Managed Care”. What is it and how does it impact my medical plan?
One thing most medical plans have in common is “Managed Care”. This includes not only HMOs, but most EPO, POS, PPO and Indemnity plans too. The term managed care refers to cost containment features imposed by insurance carriers, by a medical group, or by a State or Federal legislative body. Most plan participants encounter managed care in the form of: pre-authorization requirements imposed on surgical and other services; limits on the number of visits available for certain services such as physical therapy, out-patient counseling and chiropractic; limits on the dollar amounts an insurance carrier will pay for certain services; penalties for the inappropriate use of an emergency room and other emergency service; the use of Primary Care Physicians (PCP)/Gatekeepers; and/or capitation. Managed care features are specific to a plan and insurance carrier so you may encounter other forms of managed care. The impact of managed care on you will be specific to your plan and personal circumstance
