Quote:
Originally Posted by retiredguy123
I do think there is a difference between hmo and ppo insurance in scheduling appointments and the time the doctor spends with the patient. An hmo pays a doctor not to treat patients, while a ppo pays the doctor based on the treatment he/she performs and the doctor can bill more money for a longer visit. This may sound cynical, but it is the way it works.
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You are confusing an HMO with a capitated plan. While some HMO's operate on a capitated basis, most do not. The major difference is that in an HMO you only have coverage in network and no benefits if you go out of network. In a PPO your benefits are better in network but you have some coverage if you stray. In an HMO non-capitated plan the doctor bills on a fee for service basis just as he would in a PPO
However even in a capitated plan, no doctor is paid to not see patients. Rather the doctor is paid the same whether you are seen or not as he receives a pre-determined amount per month for managing your non-specialist care. Only if he keeps you happy will he continue to receive this monthly amount so not seeing you certainly will cost him money.