Understanding managed health care

One of the most stressful times of the year is when you have to choose your health insurance for the year. There are many reasons why last year’s choice isn’t going to be automatically renewed and all of them can cause tension. At Bachmann Insurance Agency in Flushing, MI we try to help our customers to make this important decision by providing them with the information that they need to make the correct choice. 

What is managed care?

Managed care is a way that healthcare is provided for individuals that are designed to manage cost and quality of care. An MCO (managed care organization) is in charge of negotiating with providers to determine the fee schedule for medical care procedures. Patients have varying degrees of flexibility when it comes to their own care.  


An HMO is a Health Maintenance Organization and is usually the most economical type of managed care, but is also the most restrictive. You must see providers on the network except in the event of an emergency if you want the care to be paid for. You need to have a PCP (Primary Care Physician) who is in charge of your care. Not only that, you need to get a referral from your PCP before seeing a specialist or getting tests done. 


A PPO is a Preferred Provider Organization that is the least restrictive of the managed health care plans. You don’t need a PCP and you don’t need a referral to see a specialist. You will pay more to visit a provider outside the network and your premium will be higher. 


A POS is a Point of Service and is a combination of an HMO and a PPO. You have the flexibility of the PPO and the necessity of a PCP like an HMO. 

Give Us A Call

Contact Bachmann Insurance Agency in Flushing, MI when it is time to look for health insurance.