Point of Service Plans

The Point of Service (POS) is a sort of hybrid. It primarily functions as an HMO policy. You are directed to select a PCP (primary care physician) who coordinates your care including any referrals to specialists. If you receive a referral to see a specialist you will be directed to one who is a member of the group/IPA.

The POS plan differs from the classic HMO plan in that it allows you the option of "converting" your policy into a PPO plan. If you are willing to pay a co-pay for your services, you may select a specialist from your insurance carrier’s list of preferred providers. In other words, you choose when you want to see a specialist and who you want to see.

Here's an example:

You are an asthmatic and have been sick for months with a horrible cough. Your HMO's PCP has provided you with antibiotics, inhalers, the works, but you just seem to be getting worse. At this point, you would like to be seen by a pulmonary (lung) specialist but, your physician would like to try just one more thing.

Rather than waiting, you decide to utilize the PPO feature of your Point of Service policy. You refer yourself to one of your insurance carriers PPO pulmonologists, understanding that by going outside the HMO’s group and not having a referral from your PCP, you will have a co-payment for the visit.

Here's another example:

Let's use the scenario above except this time; your PCP has decided he/she needs to refer you to a pulmonologist. Unfortunately, your group's pulmonologist has just retired. Your HMO will have cover the cost of a visit with an outside specialist because your PCP placed the referral.You pay the same amount for your visit to the specialist as you would to any HMO physician.

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