Question

An option added to some HMO plans that allows patients to choose a physician outside the HMO network is called

A. fee-for-service.
B. capitation.
C. precertification.
D. point-of-service.
E. preferred provider organization.

Answer 1

A 'point-of-service' plan is an added option to some HMO plans that allows patients to choose physicians outside their network, providing a blend of HMO and fee-for-service features. The correct option is D.

Step-by-step explanation:

An option added to some HMO plans that allows patients to choose a physician outside the HMO network is called point-of-service (POS). Unlike HMOs, where care providers are paid a fixed amount per patient, point-of-service plans offer the flexibility of seeing non-network physicians.

This type of health plan combines features from the fee-for-service approach and a standard HMO. Fee-for-service systems reimburse healthcare providers based on the specific services provided, while HMOs pay providers a fixed fee per enrolled patient, irrespective of how many services those patients use.

Point-of-service plans seek to balance the need for flexibility in provider choice with the structured cost control measures of an HMO.

In the context of healthcare financing, this means that the POS option can help in reducing the moral hazard as well as addressing the issue of adverse selection by offering more choices to patients and providers alike. Option D. is the correct one.