Concepts of Insurance Company (Medical Billing)

1.  Traditional

  i. Basic Coverage  (In-patient service)

  Its covered technical components

  ii. Major Medical Plan (Out-patient service)

  Its covered professional component

  iii. Comprehensive Coverage (both In & Out patient service)

2.  Managed Care

HMO (Health Maintenance Organization)

POS (Point of Service)

PPO (Preferred  Provider Organization)

EPO (Exclusive Provider Organization)

Concepts of Insurance Company

1.  Traditional

  i. Basic Coverage (In-patient service)   
  It Covers technical components
  ii. Major Medical Plan (Out-patient service)

  It Covers professional component
  iii. Comprehensive Coverage (both In & Out patient service)

2.  Managed Care

HMO (Health Maintenance Organization) Patient must meet PCP. Then he will refer to a specialist. Referral Authorization Number is essential.

POS (Point of Service) After meeting the PCP Patient can choose specialist from the list of providers . Out of Network Providers Covered.

PPO (Preferred  Provider Organization) Directly patient can go to the specialist. Out of Network Providers Not Covered.

EPO (Exclusive Provider Organization) Except Emergency Cases Out of Network Providers Not Covered.