Managed Care Review

Question 1

HMO

Answer 1

Health maintenance organization

Most restrictive managed care, only covers you out of network in emergencies

Question 2

POS

Answer 2

Point of service

Moderate restrictiveness, only covers out of network in rare instances

Question 3

PPO

Answer 3

Preferred provider organization

Most freedom, can go out of network but pay the highest deductible

Question 4

Utilization Management Components

Answer 4

1. PCP is gatekeeper
2. Require approval for hospital admissions
3. Step therapy
4. Deny hospital care that is deemed unnecessary

Question 5

Managed Care Backlash

Answer 5

1. too restricitve
2. providers consolidated to increase bargaining power
3. technology drives care costs not UM, it was useless