There are several types of insurance plans, and most insurance companies offer plan levels. These plans
have different types of coverage. Understanding the differences between the plans is essential in the coordination
of care and reimbursement. These differences can include prior authorizations, billing codes, and
time file limits.
Insurance plans that include home health coverage include the following:
• Preferred provider organizations (PPO)
Consumer selects a primary care physician from a list of preferred or network providers
- Plan may have copay, deductible, and/or coinsurance
- Referrals require prior approval from the primary physician
• Point of service (POS)
- Consumer selects a primary care physician
- Plan may have copay, deductible, and/or coinsurance
- Consumer is able to refer themselves to another physician
• Health maintenance organizations (HMO)
- Consumer selects a primary care physician from a list of preferred or network providers
- Most plans have copays; some may have an additional deductible
- Referrals require prior approval from the primary care physician
