HMO means Health Management Organization and is believed to be a vital component of the insurance business. HMOs are based on doctors or dentists within a network. In-network doctors work together with patients and insurance providers to give you high quality care at reasonable costs.
Health insurance companies, including CIGNA, offer a variety of plans. Each one is influenced by the capability of the client to pay the premiums as well as the needs and wants of the client. Often you can obtain full coverage dental insurance from a traditional indemnity plan. The idea behind HMOs is to give people a less costly alternative to the traditional and comprehensive health insurance plans. The major difference with PPO plans is to give you greater flexibility with your coverage but it comes with a higher up front cost out of your pocket.
CIGNA
CIGNA has a large network across the United States,and overseas with more than 5000 hospitals and more than 575,000 physicians and dentists and specialists in their networks. So how reputable is CIGNA? How long has this company been around? You generally prefer to work with a{stable}company in regards to insurance or you may not have access to the protection you need when it’s time to apply it. Way back in 1792 the Insurance Company of North America (INA) began providing insurance for mariners. In the late 1800s, the company had an overseas expansion. It really is the first American company to supply insurance in China as INA, the precursor to CIGNA. Ever since 1865 the Connecticut General Life Insurance Company was a part of the INA. It offered the first major medical insurance policies in America in 1950. It was not until 1982 when the Connecticut General Life Insurance Company and the INA combined that they created the name CIGNA. At this point, with this background, it would seem that CIGNA suits the model of a reliable company! Or at the very least, a company with a long established history.
HMO
You can find at least two different kinds of HMO, or health maintenance organization plans at CIGNA. With the combined HMO and Network plan, all patients will gain access to health care within its network When you enroll with the HMO network you select a primary care physician. This part is in reference to overall health care. The dental HMO is a different section though there is some overlap in general terms. Once you have your primary physician or dentist that person will provide regular ordinary care for you. The routine things like checkups. When you need a specialist, that is who refers you to a specialist within the same network. The part that bothers a lot of people is the fact that you need to have approval ahead of time for “out of network” care even for emergencies or urgent care needs.
Another one of CIGNA’s plans is HMO Open Access. With this program you have a lot more choice. Your specialist does not have to be from the same network. But you still need to select yo ur primary care physician or dentist from the network. The same issue with getting prior approval for visits to urgent care or emergency facilities is troublesome with this plan too. The plan provides a patient with more freedom of choice in selecting a doctor, however you must use doctors within CIGNA’s network.
Just when you think you have a clear idea of what HMOs are available at CIGNA, you discover the company has just created nine new HMO plans! Now, there are nine new HMO plans available for the public sector and for Taft-Hartley unions. Each of these has variations to meet the needs of this diverse population. This is apparently an attempt to mitigate the insurance crisis in America, particularly regarding dental care.
Look Closely at Dental Insurance
PPO
Let’s look at the PPO plan provided by CIGNA. Remember, PPO is the preferred provider organization. Each client has the liberty to choose their own physician or dentist or facility regardless of network affiliation. You do not have to name a primary care physician or dentist to receive care. Nor do you have to get a referral prior to seeing a specialist.
The issue of emergency care is handled a bit differently too. You do not have to have prior approval but you should know that any emergency care will be covered only up to the level of an in-network payment. Plus, in order to get reimbursed for your payment for those services, you must submit a claim to CIGNA, yourself.
As you can see it is to your best advantage to weigh the alternatives and give due consideration to the pros and cons of each plan before you select an insurance policy. That assumes you are privately insured. If your employer is giving you insurance as a benefit, you may not have a choice in the type of policy but you really need to have a clear understanding of what is covered and how it operates.
The short version is:
- HMO gives you low cost and comprehensive health and/or dental care. But with restrictions.
- HMO Open Access is a bit more flexible regarding network restrictions and it will give comprehensive coverage also. But it has higher premiums.
- The PPO plans offer you more freedom to select where to get health or dental care and which physician or dentist to use. But it has even higher premiums.
Read More Dental Insurance Plans Articles:
- What Are Dental Insurance Indemnity Plans? Please refer to the previous post for an overview of different types of dental insurance plans. There is enough information...
- Dental HMO Plans A Dental HMO plan will generally give you the most complete level of benefits with the least cost. The HMO...
- What Are PPO Dental Plans? What about PPO (Participating Providers) Dental Plans? PPOs are another method that people use often to help pay for their...
- CIGNA Responds to Dental Insurance Crisis? CIGNA is one of the top insurance companies in the USA. CIGNA products and services are available in 29 countries. ...
- Dental Insurance Plans – PPO or HMO or DMO – Which is Best? Take A Closer Look at Dental Insurance Plans. Compare PPO vs DMO and HMO alternatives to sort them out. Which...
