FEHB Plan Quality

For traditional fee-for-service insurance plans, service quality used to be a minor issue. The main service concerns were how easily you could get help from plan representatives regarding coverage questions and how fairly and promptly claims were paid.

Now even fee-for-service plans now have some involvement in the quality of your health care. All plans require you to get authorization before hospitalization or surgery. And almost all have assembled networks of preferred providers and have prescription drug formularies. Because you save money by using providers from these networks and preferred drugs in these formularies, the availability and quality of preferred providers and the lists of preferred drugs are important.

An HMO can have an even bigger impact on the quality of medical care its members receive. With an HMO, your choice of physicians, hospitals, and other healthcare providers is limited to a selected list of participating providers. It may be set up so that you primary care doctor is a “gatekeeper” who decides whether to authorize referrals to specialty care and other services.
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