Hmo,ppo,pos, Open Access Plus

Dec 17, 2007

  1. Ins155
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    Can anyone tell me what does an "open access plus plan" fall under... HMO,PPO,POS etc. I have an open access plus plan through my employer and I can go to any doctor that accepts my insurance without a referral even specialists without ever seeing a primary physician. All I pay is a co-pay.
     
    Last edited: Dec 17, 2007
    Ins155, Dec 17, 2007
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  2. GreenSky
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    It's an HMO with direct access for office visits within the medical group. Be careful in that it may still require referrals for tests, hospital, etc.

    Rick
     
    GreenSky, Dec 17, 2007
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  3. Ins155
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    I have to say, I have never had to worry about any tests or referrals at all except for my co-pay. I've had surgery and my son has had (5) surgeries and never paid anything other than my co-pay. After reading the "prelicensing" material for my L&H license, I was confused as to where my own health insurance would fall under. Several times doctors offices staff would tell me "you need a referral for this etc." and I would argue that I do not need any referrals, only to have them check with my insurance and then apoligize to me saying "sorry you don't need a referral but most of the time people do." Also a family member works for a doctor as an office manager and she said because its "open access plus" it is not an HMO.
     
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    Ins155, Dec 17, 2007
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  4. GreenSky
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    Then why did you ask about it?

    Rick
     
    GreenSky, Dec 17, 2007
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  5. Ins155
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    Because I thought I would ask someone on here that would know the business better than she does. Was I wrong for asking? You say, why do I ask then? Now I have you who say it is an HMO and her who says it is not. I believed it was, now that you also say it is I tend to believe my original feelings that it is an HMO unless someone else on here convinces me otherwise.
     
    Ins155, Dec 17, 2007
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  6. GreenSky
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    Fair enough. If you find it other than an HMO please post the information.

    But, since a PPO never needs referrals, by definition "open access" does not apply. Same with a POS. It simply combines HMO and PPO.

    The only thing left is an HMO. A "closed access" would be the traditional HMO. Wait for a referral until you are too sick to be cured.

    Didn't mean to jump on you but it seemed like you had an answer and wanted to accept that and really wasn't asking for information.

    Rick
     
    GreenSky, Dec 17, 2007
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  7. Ins155
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    No problem. Thanks for your feedback. Once again I believed it was under an HMO, she thought differently. So I thought where better to go and get the answer than on this site. Thanks again.
     
    Ins155, Dec 17, 2007
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