Health Insurance PPOs, HMOs, CDHPs Explained... Learn Price-Transparency and Other Tricks
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- Опубліковано 6 гру 2021
- Health Insurance Plan Designs are VERY Confusing. This Video Explains Them All:
PPO Plans - Learn How Family Deductibles and In-Network and Out-of-Network Benefits REALLY Work.
POS Plans - Learn How Out-of-Network Doctor and Hospital Services Are Usually NOT Covered.
HMO Plans - Learn How Primary Care Physician (PCP) Gatekeepers Control IF You Can See a Specialist and HOW They Tell You Exactly Who You Can and CANNOT See.
CDHP Plans - Health Savings Accounts, Health Reimbursements Replace Copays... Learn the Implications.
Price-Transparency - In-Network Prices for the Same Service with the Same Insurance Differ by 500% or More Depending on the Doctor and Hospital. Don't Get Caught with a HUGE Bill.
Reference-Based Pricing - Some Health Insurance Plans Opt-Out of the In-Network Game... But There are Some Hidden Consequences.
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Dr. Bricker…I have been alive on this planet for 31 years, and you are the first human being who has actually described the different healthcare plans in a way that makes sense. Thanks.
Super! Thank you for watching and for your comment.
hahahahhahah....yes
I am a family nurse practitioner who thoroughly enjoy your presentations. You’ve made it so easy to understand this complicated world of insurance. I have learned so much from your classes even better than anything that I have learned in school. Please keep up the good work. Thank you.
Thank you for watching and for your comment.
i have been alive on tis planet for 31 years , and you are the first human being who have actully described the
Thank you for watching.
The first rule of healthcare in this country: Don't get sick
#True.
Excellent presentation. You made a complex topic very simple.
Thank you for watching.
Your videos are very useful and provide lots of information. I have received lots of help after watching this post, please continue to share this kind of information. Thank you.
Great explanation of components of health insurance process - co-pay, deductibles, accounts, out of pocket max, and different insurance plans!
Thank you for your feedback.
This man needs an award 🥇
🤣😉 Thank you.
Sound advice! I will follow you from now on. Keep up the AWESOME WORK!
Thank you for your positive feedback.
Great explanation, thank you!
Thank you for watching.
Thanks for the information. That helps me, as a postal (or any federal ) employee make an informed decision on whether we need to change our health plan during our open season
Thank you for watching!!
Thank you for this comphrensive explanation.
Thank you for watching.
Thank U great video👍🏽🥰
Thank you for watching and for the feedback.
Thanks for the information! 😇
Thank you for watching.
Great video, thank you for putting this information out in a way that is understandable
Thank you for watching and for your feedback.
@@ahealthcarez I’ve learned a lot this year dealing with shady practices from United Healthcare. They’ve taken hours of my time and attempted to get out of paying thousands.
The more I learn about health insurance, the more I’m worried for the USA. It’s eating us alive.
great video
Thank you for watching and for your feedback.
I have a health sharing ministry. I pay and get reimbursed. I shop around. I also read the reports to see if I really need that test. Check choose wisely. Try to do direct primary care. I am in control of my healthcare not the plans or insurances.
Good for you! Thank you for sharing.
Wish all insurance plans were this good LOL
Thank you for watching and for your comment.
Wished I found this 2 years ago!
Thank you for watching.
Does any other country make this as difficult as the US?
Good question. No.
Hi Dr. Bricker, I haven’t finished watching the video yet, but I was wondering about cost sharing. For in network in particular, are plans with copays, co insurance, and deductibles driven by insurance (I.e. insurance wants to save money through cost sharing) or through consumer preference (I.e. consumers tend to purchase the lowest premium plan)? Thank you.
Great question. Plan choices dictated by employer. Most people don’t use their insurance much, so choose plan with lowest premium and highest cost share.
Schools and govt usually offer lowest premiums with lowest cost-share… ie best insurance coverage.
Have you thought about doing a series on essentials for healthcare investors?
Thank you for your suggestion.
Thank you
Thank you for watching.
thanks
Thank you for watching.
Is an “embedded family deductible” the same as a “traditional family deductible”? Could you please explain the difference with a “true family deductible”?
Hi Dr. Bricker! Thank you for creating this simplified explanation of medical care coverage! I have a question for you. I will be working for a small business for the first time, and they offer POS insurance. For primary care visits, the insurance plan says "Deductible, then 0% coinsurance". What does this mean? I thought POS plans covered primary care visits just like PPO plans. Also, does a POS plan require a referral for all specialist care? For example, if I need to go to the gynecologist, would that require a referral?
All good questions. The plan does not have to have copays, so you will need to pay for your PCP visits until you reach your deductible… I think.
POS plans typically do NOT require referrals to see a specialist.
Thanks
Thank you for watching.
I don't want to understand but I'm grown now have to accept these Terms and Agreements because I'm an adult now
Aww me too
Hi Dr. Bricker,
Would love to know what your thoughts are about digital pharmacy companies like Capsule, Truepill etc and how they make money. How are they different than PBM owned Pharmacies?
Thank you for watching and for your question. I’ll have to look into them.
"Health Insurance" is the monetization of the (unenforceable) promise of future performance of non-disclosed 'allowed' goods and services by non-obligated contractors (licensed medical providers) at unknown prices.
To be clear: the monetization flows only to the seller of this financial contract aka 'Insurance', and benefits neither Buyer or Seller in the actual healthcare transaction.
Thank you for sharing your thoughts.
@ahealthcarez Solution: DAO direct pay "options market". Humans may purchase discrete (unbundled) options from licensed medical professionals, with premiums paid to the med-.pros.
Med-pros then contractually obligated to provide the specific described services, in return for the precisely defined prices, before the options expire.
Think how this enables surge/or discount pricing, rewarding excellence relative to mediocrity of performance, and overall incentives for the strained-beyond-limits provision community.
Thank you for the great video! Am I right that an HDHP can be an HMO, POS, PPO or EPO? Like different rules about in network/out of network and referrals, but just with High Deductible and HSA?
If a high deductible health plan has an associated Health Savings account, by law that plan cannot have copays.
All those plan types you mentioned need to have the copays taken out if they are going to be put alongside an HSA.
Thank you for watching.
@@ahealthcarez Thank you! And they could have In Network, Out of Network and PSP Gatekeepers?
@@ahealthcarezWhat happens when you reach the family out of pocket on a high deductible plan? There are no copays, does it mean services are free from then on?
Dr.Bricker, I myself work as admin for a cardiology specialist Dr. .... typically when I run a patients insurance and their OOP has been met we no longer charge them, including any needed testing. Am i misunderstanding something along the way ?
should we still charge their co-pay ?
Great question. Depends on plan design. Best thing for patient would be to bill insurance and see on EOB if patient responsibility. If Yes, then bill later.
this guy is like the Scotty Kilmer of health insurance
Thanks. I love that guy! 😉
Q: Does the co-insurance for PPO and CDHP count towards the out-of-pocket max?
Good question: Yes.
Re PPOs...it behooves those policy members to stay all out of network vs all in network.
Thank you for sharing your thoughts.
@@ahealthcarez do you have a video discussing married couples who both can receive employer health insurance? Like considerations about whether to waive one policy to join the other, or if when if ever dual coverage is sensible if possible, HSA considerations, etc?
So, to clarify on a family plan with these figures your deductible and out of pocket max cannot be satisfied by one individual. In other words, If I incur $5000 worth of medical expenses alone, it does not count? Someone else in my family has to contribute as well? If so, does it have to be equally? I'm still confused by this part
Correct. Correct. 2 people must meet the individual deductible amount separately.
It is confusing. Hope that helps a little.
I have a rare back condition and I have an HMO insurance and the only specialist that only a few doctors do this kind of procedure cuz I need surgery is out-of-network I'm trying to do an appeal I don't know if I'm going to be approved...what is your experience in hmo paying out of network for needed surgery?
Must go through their appeal process. There is a chance.
@@ahealthcarez Thank you 🙏
Please advise which plan is good for IVF treatment
Depends on your state. Some states require IVF coverage in health insurance (e.g. Massachusetts), but most states do not. Therefore, most insurance plans do not cover it.
I want the flow chart of insurance steps how to approach reimbursement procesd
Thank you for your suggestion.
Who will submit the EOB documents
Do copays count towards your maximum out of pocket?
Great question. Yes, but not towards the deductible… just to make things more confusing.
How does tricare pos work?
Thank you for your question.
@@ahealthcarez please enlighten us on tricare and their designations as I am still learning about it and you are a great person in the matter
CDHP is at 16:40
Thank you for the time stamp.
the part about you having to pay copays even after meeting your out of pocket max isn't this false? you insurance should cover 100% then after . ? this has been verified by most insurance companies. correct me if im wrong?
You are correct. I think he's confused a little bit about how the copays interact with the OOP. Usually copays don't count "towards" meeting the OOP, but once you've met the OOP there are no more costs to you for the remainder of the plan year.
HMO is epo correct?
Close, but they are different. HMO has PCP gatekeeper. EPO does not. Both do not have coverage for out-of-network services.
Don't go for hdfc it's totally waste
Those HMO copays are not that cheap
Thank you for watching and sharing your perspective.
The premiums here in Northern CA are expensive
What a pain in the a
True. Thank you for watching.