Point of Service (POS) Health Plans

Point of Service (POS) health insurance plans offer a hybrid approach that combines some of the best features provided by PPO and HMO policies. Of course, there are some potential downsides to choosing a POS, too. No insurance plan has features that will appeal to everyone. Before you purchase any health insurance policy, make sure you learn about POS options. You may determine that a POS health plan has the right price and services for you or your family.

POS Networks

Much like Health Maintenance Organization (HMO) plans, POS policies have networks of preferred service providers. HMO plans often refuse to pay for any services from doctors outside of their networks. POS policies aren’t as restrictive.

When it comes to provider networks, POS plans resemble Preferred Provider Organization (PPO) policies in that they let you choose any doctor you want. Unlike PPO plans, though, you have to select a PCP when you buy a POS policy.

Out-of-Network Services

POS health insurance makes it relatively easy for you to get services from doctors outside of your network. Whether your insurance pays your bills depends on whether your PCP gives you a referral.

As long as your PCP writes a referral for you to see an out-of-network specialist, your POS policy pays for the services just like it pays for services from in-network doctors. If you do not get a referral from your PCP, then your policy probably will not pay your healthcare bill from an out-of-network doctor. Some plans may pay a portion of the bill, but you will still face higher out-of-pocket costs.

POS Costs

POS health insurance prices usually fall between the costs of PPO and HMO plans. They don’t cost as much as PPO plans because they don’t give you as much freedom as PPOs. They cost more than HMO plans, though, because you can get services from doctors outside of your network.

Most PPO plans require you to make a co-payment when you receive services from a healthcare provider. The amount that you pay depends on your PPO policy, though. Some policies may charge co-payments as little as $10. Others may have you pay $35 or more. Remember that your PPO health insurance policy will only cover out-of-network services when you get a referral from your PCP. Without the referral, you could get stuck with high medical bills.

POS Advantages

POS health insurance policies offer a lot of advantages for most people. Many patients like POS plans because they get to choose their own PCPs. That way, they can continue seeing doctors they already know and trust.

POS also has some cost advantages. They aren’t the cheapest option, but they offer exceptional flexibility without charging the high prices often associated with PPO policies.

Finally, people often prefer POS plans because they can avoid deductibles. Many POS policies do not have annual deductibles. With an HMO or PPO plan, you have to spend a certain amount of money before the health insurance company will start paying your bills. The deductible could fall anywhere from a couple hundred dollars to a few thousand dollars. Since most POS plans don’t have deductibles, your insurance provider starts picking up a part of your medical tab as soon as you use your policy. That helps keep your out-of-pocket expenses low.

Keep in mind that some POS plans do come with deductible requirements. Always check policies for deductibles before you purchase them. In many cases, choosing a higher deductible can lower your monthly premiums. On the other hand, high deductibles mean that you will pay more for the healthcare services you need.

POS Concerns

The opportunity to go out of network can create problems for some people. The option to see an out-of-network doctor may sound great, but it often leads to higher prices and a lot of paperwork.

If you don’t get a referral from your PCP, then you may need to pay the full cost of your out-of-network medical bills. Even basic tests and services can cost thousands of dollars.

Out-of-network paperwork can also generate a lot of confusing documents. Doctors and specialists outside of your network may not want to deal with your insurance company. When the doctor’s office refuses to handle your paperwork, you have to find the right forms, fill them out, and submit them to your insurance company.

Filling out a few documents might not sound like a big deal. You’ll likely change your mind when you see the amount of paperwork involved. You might have to complete documents for each service that you receive. That could mean filling out paperwork for seeing your doctor, talking to a nurse, having blood drawn, getting diagnostic tests, and filling prescriptions. It doesn’t take long before you wish that you had taken the time to get a referral from your PCP.

A lot of people love POS health insurance plans. In most cases, they can work well as long as you understand how the policies work. If you don’t mind the inconvenience of seeing your PCP for referrals, then a POS policy could suit your needs quite well.