What is the Difference between an HMO and a PPO?

I accept both PPO and POS insurance. I do not accept HMOs, as it has been my experience that HMOs are not compatible with confidential psychotherapy. Sensitive information must be reported to the HMO, which has a right to oversee treatment.

If you have any questions about your insurance plan, please contact your insurance carrier. If you have further questions, I will be happy to try and answer them.

Preferred provider organization (PPO)

If you have a preferred provider organization (PPO) you are entitled to see any licensed mental health provider. You do not need a referral (permission) from a primary care physician. At times, your co-pay may be slightly higher, but much of the cost will be covered by your health insurance plan.

Health Maintenance Organization (HMO)

If you have a health maintenance organization (HMO), you are required to choose a mental health provider from a list compiled by the insurance company. If the provider is not on that list, your insurance will not cover treatment. In addition, you will probably need a referral from your primary care physician.

Point-of-service (POS) plans

A point-of-service (POS) plan offers a combination of PPO health insurance and HMO insurance services. The “point of service” in the name reflects the fact that you may choose whether to use HMO or PPO services each time you see a provider.

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