Page 64 - The Informed Fed--Hearn (edited 10.29.20)

HDHP PPO/FFS HMO
Red tape
/paperwork Lots Some Almost none
Emphasis on
keeping you Cost Pre-approval Non-hospital
out of the incentives treatment first
hospital
Choices of Some are In network Must use
doctors, network only; reduces cost; in-network
hospitals and others pay out-of-network providers; no
other something provides coverage for
providers for out-of- increased costs out-of-network
network
Use case
management Limited Limited Substantial

In terms of paperwork, an HMO is the easiest to deal with, while the
High-Deductible Health plan involves more paperwork and pre-
authorizations. The High-Deductible Health plan provides incentives to
the plan participant in taking responsibility for their care, while the PPO
and Fee-for-Service plans require pre-authorization, and the HMO
endorses non-hospital treatments. All three types of plans require you to
utilize their preferred providers to different degrees. It’s your
responsibility to understand what is required by the plan in order to avoid
unnecessary out-of-pocket expenses for yourself.
Each of the High-Deductible Health Plans and the PPO/FFS have
limited case management capabilities. This means you will be responsible
for managing more of your overall health care. For example, if you’re
having surgery, you’ll need to be sure that not only the hospital and
surgeon are on your insurer’s preferred provider list, but that the
anesthesiologist and any other medical professionals who might consult

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