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Private
Medical Insurance
 Managed Care
In
an effort to control costs associated with unregulated fee-for-service
programs, a “managed care” policy
offers coverage of services and equipment screened and coordinated
through
a “gatekeeper” and often provided by pre-selected
providers. Managed care programs many take a variety of forms:
Health Maintenance
Organizations (HMO), Preferred Provider Organizations (PPO),
Managed Care Organizations (MCO). Durable Medical Equipment may
be available
to a managed care policy subscriber only through the supplier
with whom the organization has a contractual relationship. Problems
with accessing funding through a private insurer can often be
best
addressed
through the employer (Personnel or Benefits
Department) who has
offered the plan to the employees.
Fee-For-Service
Prior
to managed care, private insurance was organized around a “fee-for-service” model.
Some of consumers may still have this type of policy. Durable
Medical Equipment is
a specific
covered item in the policy. A request for payment is submitted
with a letter of justification outlining the medical need.
Policy varying
regarding the amount of coverage, but 80% covered and 20% co-pay
is the norm for private insurance.
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