What is HMO and PPO insurance systems? How do they affect access to care for patients in US?

hi guys is tarpit from capping simplified and today I'm gonna speak to your water very interesting topic US health care have you ever determined your supplemental answer the word access to challenge code completely understanding what it means have you gone into an.

Interview thinking only answer the question if somebody asks me so what is your understanding of US health care are you mind bottle by world like HMO PPO health plan PBM insurance providers Medicare Medicaid open deductibles so on and so forth well this video series of ten videos is going to help solve answered all those questions and get you.

On the top of this insurance game HMO vs PPO first why is important if you were to walk into an interview and say that you know something about the US health care system you probably want to know what an action morality of your system is it will really help you show how much knowledge you've gained about health care system from your reservations.

Number two if you've had a dental office practice later in the future and that's your long-term pool you would have to file with one of two health insurance organizations over HMO or a PPO and that would remand is sleep change the kind of patient pool that you will be providing capital at the end of this video you will be able to make that decision based.

On the knowledge I provide first let's discuss what a fetch temos a health maintenance organization an insurance company that either with several employers will then go and hire with a certain set of prescribers doctors dentists and so on everybody that they develop a contract with are called doctors in their network so HMO has.

Doctors they have definite contracts it and only to those people they have to they provide special benefits you could be one of them if you tie up with that for a patient this means two things number one if a patient has to get a prescription trouble let's say endocrinologist or orthodontist they cannot do that directly they have to go.

Through a gateway and who is this gateway a general Doug a general doctor that could be a a PCP in primary care physician or a general practice dentist without getting the first consultation from that gateway they cannot go to a specialist so if I know which specialist I need to go to and if I know when I need to go to them.

As a patient again a prescription I have to go through to consultations each and every time and each and this also complicates put each and every member of my family with as an employee I mind that healthcare insurance provides for all my dependence as then this are two things about national there are two nuances you don't you do not.

Have to go through a primary care physician or a general dentist dentists in two cases number one if you have an emergency case obviously not number two if you are a woman what who's going to meet your gynecologist then you don't have to get a prescription from a primary care physician these are the nuances of a HMO a hatch you is.

Generally more expensive than a PPO but on the other hand the amount of paperwork where a patient has to go through yet their services is pretty less why is this because an HMO has a very well mint organization of in network hospitals dental care providers doctors specialists some stencil consultants and so on because all of.

Them are then made the paperwork that you need to go through between these consultations becomes far less ill and well coordinated by our insurance company or by hotel system that's why which must be a good option for patients for willing to pay the extra buck so let's see what PPO means a PPO is a preferred provider organization probably.

Less than 40% of America are in PPO systems especially in the West Coast California you go ask about Kaiser probability and they would not have a yes a PPO is this they have doctors in their network doctors with whom they develop a contract on hospital systems dental systems to develop a contract with.

Within these systems they let patients come in and get their services let's see from patient perspective why a PPO could be different number one if I was to visit I were to visit a specialist I don't have to go through a PCP or general dentists I can directly use the specialist that means an extra consultation is reduced number two if I.

Want to visit some doctor who's outside the PPOs Network I can and guess what they would reimburse for that concentration of them except they would not reimburse as much as they would put a doctor at inside the network so if I have two choices adopted in the PPO Network versus outside I can get consulted by both people unlike HMO.

Value can only get converted by a doctor in the HMO Network now another critical nuance is BP was used to be very expensive compact HMOs but now it's become a lot cheaper at what cost add the cost of paperwork if you were to go get a consultation from many PP o–'s let's say a specialist agenda practice doctor and after that is endodontists.

And then you want to go to somebody outside the network the amount of paperwork that you have to go through chest quadruples in are triples and quadruples in complicate step this is a setting for an independent you know patient unless they've already built loyalties with certain set of doctors and they know what the paperwork is.

Going to be so what do we want to gain from this so what does our takeaways in the future if you want to be a doctor you would have to choose one of two services either attentional on a PPO depending on HMO or a PPO you would develop a contract these two insurance organizations if you were to go to an.

HMO you would be one part of a closed set of doctors and the people you could refer the patient to you are limited in the number of dentists said you put our specialist you could refer your patient to outside of that you have a very captive audience because the patient is restricted from visiting any after that they want and only can.

Visit doctors with him dead within that small Network you're technically already have an audience how patient population who's lying to you in some way lies because of barriers that could be a good thing and if you can prove your your credibility they became coming to you also it reduces paperwork for the patient that means it's lower amount of.

Paperwork and lower amount of counseling amount of headache that they would have to go through they get access to cap trade uses automated Li if you were in a PPO would be completing with open masses because now your patient has to go through hope more people will treat you there's not get a referral from a different doctor and then go to a doctor.

Even outside the PPO network because of this competition yes you lose some kind of with captivity which our patient population has and you will have to prove your credibility they market yourself but definitely you can build it a direct loyalty without having a gateway like a PCP standing in between you and the patient so if you are a.

Specialist probably a PPO makes medicine you can create loyalty you are a gentle package the HMO makes sense especially here in California and the power of competition that's it let's see in video number two you want to make your application fast easier in some time now
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