Insurers maintain lists of health practitioners who are authorized to provide patients with services under a health maintenance organization or preferred provider organization plan, explains Inc. Subscribers must select providers from these lists for their insurer to cover their expenses or are otherwise responsible for a larger share of costs.
Under traditional fee-for-service insurance plans, subscribers may seek care from any medical practitioner of their choosing, according to Inc. Plan members are then reimbursed for their expenses according to a specified model that may require patients to pay a variable or fixed portion. Under HMO or PPO plans, insurers contract with independent providers or groups of providers, and in some cases directly own and operate medical practices and hospitals. As a result, insurers are able to reduce their costs through bulk buying power and through efficiencies such as simplified claims procedures within the provider network.
Under HMO plans, subscribers are generally required to select care providers from within the insurer's network to receive any coverage, except when travelling or in an emergency, notes Inc. Under PPO plans, subscribers have the option of seeking out-of-network care, but are compensated for a smaller portion of their costs. Point of service plans are an in-between model that allows limited access to out-of-network services at a greater cost than under PPO plans, according to eHealth. Insurers such as Blue Shield and Humana provide tools on their websites to help subscribers find in-network providers by searching for doctors, dentists, and vision care specialists using their specific plan type.