Health Care Administration

Question 1

HMO/Health Maintenance Organization

Answer 1

delivers all health services through a network of healthcare providers and facilities; least freedom to choose providers; require referal to see a specialist

Question 2

PPO/Preffered Provider Organization

Answer 2

A moderate amount of freedom to choose your health care providers – more than an HMO; you do not have to get a referral from a primary care doctor to see a specialist; Higher out-of-pocket costs if you see out-of-network doctors vs. in-network providers

Question 3

EPO/Exclusive Provider Organization

Answer 3

A moderate amount of freedom to choose your health care providers – more than an HMO; you do not have to get a referral from a primary care doctor to see a specialist; No coverage for out-of-network providers; Lower premium than a PPO

Question 4

POS/Point of Service Plan

Answer 4

blends features of an HMO with a PPO; You can see in-network providers your primary care doctor refers you to. You can see out-of-network doctors, but you’ll pay more.

Question 5

Gated Vs. Non Gated

Answer 5

Refers to the need to obtain a referral from your primary care physician before seeing a specialist. With a “Gated” plan, you need a referral, with a “Non-Gated” plan, you don’t.

Question 6

Patient Chart/Medical Chart

Answer 6

a thorough record of a patient’s medical history and clinical data