100 E. Pine St, STE 110 Orlando, FL 32801
| Best Practices for U.S. Healthcare |
PROVIDER ADVISOR
Premium Provider Networks
A Premium Provider Network can be referencing any group/network of pre-qualified healthcare providers that is readily accessible to a particular healthcare consumer.
A ‘Premium or Preferred Provider Network’ can be referencing any group/network of pre-qualified healthcare providers that is readily accessible to a particular healthcare consumer. However, these terms are most often referred to in the context of the quality provider networks that are available through traditional PPO Health Insurance Policies.
PPO stands for ‘Preferred Provider Organization’ which refers to a type of preferential coverage policy that is written by Private Health Insurance Carriers.
There is typically an extensive network of healthcare providers (MDs, Nurses, PAs, etc) and other resources accessible to the beneficiaries of a PPO health insurance plan.
And access to these large provider/care networks is actually the main differentiating factor re: available coverage benefits of PPO Policies versus those of HMO Policies.
HMO stands for ‘Health Maintenance Organization’, and this type of health insurance policy tends to offer a much smaller network of healthcare providers to its policyholders and beneficiaries - usually in exchange for cheaper monthly premiums than PPO plans.
While PPO and HMO policies are the two high-level categories that most carriers designate, the private health insurance market also offers additional pricing tiers, specialized carve-out benefits, supplemental/elective coverage options, & more.
But having a traditional PPO policy with top-tier benefits is not the only way to access preferred providers and/or premium care networks. Consumers can research their HMO, supplemental, and/or government networks to best leverage ‘managed care’; they can elect for alternative coverage options like Telehealth Memberships; and they can even find DTC web forums/storefronts or go direct-to-provider (DTP) in the age of digital health - where web technology is always creating new care opportunities.
Innovations are definitely needed because the current system is fragmented at best. A diverse gene pool of 330 million people, the particularities of different religious/cultural practices, and a lack of proper nourishment (agriculture & food processes) are some of the things that make serving the needs of U.S. healthcare consumers very difficult.
Plus the complex strongholds of interdependent corporate industry widely found in ‘Western Medicine’ present serious conflicts of interest. All of these factors contribute to a significant resistance to the system changing at large.
And that is why integrative solutions (plus a creative mentality) are now required for the masses of healthcare consumers working to reach best practice providers/facilities.
It is important to take an integrative approach to curating network/membership resources for consumers accordingly. This means ensuring that every level of healthcare consumer has access to both traditional & alternative options.
Personalized Coverage Needs
U.S. healthcare consumers have many things to consider when it comes to getting proper membership coverage in a very complex market. And what works for one person might not be the answer for someone else.
​
Simply put, different consumers have different coverage needs.
Questions to Answer When
Shopping for Health Insurance:
Are you looking for an Individual or Family Policy?
How often are you planning to access health providers/services?
Do you (or your family) have any pre-existing conditions?
What primary and/or specialty care needs do you anticipate?
Which carriers offer the best provider networks in your area?
Premium PPO? Discounted HMO? Catastrophic +Telehealth?
Options through an active employer or a government organization?
Self-Advocating: Fully Covered to Non-Covered
A Premium Provider Network can be referencing any group/network of pre-qualified healthcare providers that is readily accessible to a particular healthcare consumer.
Unfortunately, there is more work to be done even after having received insurance coverage as a healthcare consumer. It is now time to self-advocate in order to become literate with health policy language. It should not be taken lightly that all consumers MUST BE FAMILIAR with general health insurance terms in order to properly access their covered benefits.
And this means that anyone using insurance (either private or public) to finance healthcare services will want to proactively learn about the underwriting of their policy. This can be achieved by exploring the terms listed below as they relate to a consumer’s specific coverage variables