Final answer:
The key difference in whether you need to submit insurance claims and handle paperwork is dependent on whether you are part of an HMO, which usually requires no claim filing for in-network services, versus PPOs, EPOs, and POS plans, which may require you to file a claim, especially for out-of-network care.
Step-by-step explanation:
The sixth basic way HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations), EPOs (Exclusive Provider Organizations), and POS (Point-of-Service) plans are different is related to whether or not you have to file insurance claims and do paperwork. In an HMO, typically, you do not need to submit claims; the HMO handles all the paperwork as long as you visit doctors and facilities within the HMO's network. On the other hand, PPOs, EPOs, and POS plans might require the policyholder to file a claim, especially if care is sought outside the provider's network. This is because these types of plans offer more flexibility in choosing healthcare providers and might operate on a fee-for-service basis, where providers are reimbursed for each service they perform, rather than a fixed per-person rate like HMOs, which can lead to a need for more direct involvement in the claims process by patients.