Which type of managed care organization typically has the least flexibility for patients regarding provider choice?

Prepare for the Certified Specialist Payment Rep Exam with detailed flashcards and multiple-choice questions. Each question includes hints and explanations to help boost your readiness. Master your exam preparation journey now!

The correct choice is HMO, which stands for Health Maintenance Organization. HMOs typically require members to select a primary care physician (PCP) and obtain referrals from this PCP to see specialists. This structure limits flexibility in terms of provider choice because members must typically receive all non-emergency care through their designated network of providers. If they choose to see a provider outside of this network, most HMOs will not cover the costs, leading to higher out-of-pocket expenses for the members.

In contrast, other types of managed care organizations, like PPOs (Preferred Provider Organizations) and POS (Point of Service) plans, offer more flexibility in choosing providers, allowing members to see specialists without a referral and offering partial coverage for out-of-network services. EPOs (Exclusive Provider Organizations) can also have limited networks similar to HMOs but usually do not require referrals in the same way, giving members more freedom when accessing specialist care.

Subscribe

Get the latest from Examzify

You can unsubscribe at any time. Read our privacy policy