Question

Mr. Polanski likes the cost of an HMO plan available in his area, but would like to be able to visit one or two doctors who aren’t participating providers. He wants to know if the Point of Service (POS) option available with some HMOs will be of any help in this situation. What should you tell him?

Answer 1

Answer:

The POS option might be a good solution for him as it will allow him to visit out-of-network providers, generally without prior approval. However, he should be aware that it is likely he will have to pay higher cost-sharing for services from out-of-network providers.

Explanation:

Answer 2

It is best for Mr. Polanski to choose the HMO-POS plan.

Explanation:

Mr. Polanski can choose the HMO-POS plan instead of HMO plan.  The HMO-POS plan has all the features of HMO plan. In addition to that it allows Mr. Polanski to choose some of the providers who are not in the HMO network also.  

However, for this, he has to get prior referral and authorization from his PCP before visiting the providers.  Though this accounts for some deductibles and premium separately, this plan is better than HMO plan.