State of California California Department of Consumer Affairs

Health Benefits Program (Types)

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'''Managed care health plans generally fall into three categories as follows:'''<br>
'''Managed care health plans generally fall into three categories as follows:'''<br>
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<p>Members are restricted to seeing HMO physicians. Usually, doctor visits outside the plan are not covered. The patient's primary physician will control patient access to specialists. Doctors may be employed by the HMO or practice independently. HMO's are regulated by the '''Department of Managed Health Care'''.</p><br>
<p>Members are restricted to seeing HMO physicians. Usually, doctor visits outside the plan are not covered. The patient's primary physician will control patient access to specialists. Doctors may be employed by the HMO or practice independently. HMO's are regulated by the '''Department of Managed Health Care'''.</p><br>
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'''<font color="#4AA02C">Department of Managed Health Care</font color="#4AA02C">'''<br>
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'''California HMO Help Center'''<br>
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7667 Folsom Boulevard, Suite 102<br>
 +
Sacramento, CA 95826<br>
 +
 +
 +
'''Mailing address for complaints:'''<br>
 +
'''<font color="#4AA02C">California HMO Help Center</font color="#4AA02C">'''<br>
 +
980 Ninth Street, Suite 500<br>
 +
Sacramento, CA 95814-2725<br>
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(888) 466(HMO)-2219<br> 
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(877) 688-9891 TDD<br>
 +
(916) 229-0465 Fax<br>
 +
[http://www.hmohelp.ca.gov/ '''www.hmohelp.ca.gov''']<br>
 +
 +
<p>Assistance is available 24 hours per day, 7 days a week for consumers who need assistance with their HMO. Call center staff can assist consumers with a variety of issues including (but not limited to) quality of care, prescriptions, preventative testing, and information regarding the DMHC's complaint process.</p><br>
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<p>'''Publications available:''' The California Patient's Guide: Your Health Care Rights and Remedies</p> 
'''Point-of-Service (POS)'''<br>  
'''Point-of-Service (POS)'''<br>  
<p>A Preferred Provider Organization is basically a group of doctors who negotiate discounts with insurers. Unlike HMO's, there may be no restrictions on seeing specialists; however, members pay higher costs if they see non-PPO physicians. These plans are regulated by the '''Department of Insurance'''.</p><br>
<p>A Preferred Provider Organization is basically a group of doctors who negotiate discounts with insurers. Unlike HMO's, there may be no restrictions on seeing specialists; however, members pay higher costs if they see non-PPO physicians. These plans are regulated by the '''Department of Insurance'''.</p><br>
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'''<font color="#4AA02C">Department of Insurance</font color="#4AA02C">'''<br>
 +
'''Consumer Services Division'''<br>
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(800) 927-HELP (4357)(within California)<br>
 +
(213) 897-8921 (out of state)<br>
 +
300 South Spring Street, South Tower<br>
 +
Los Angeles, CA 90013<br>
 +
[http://www.insurance.ca.gov/ '''www.insurance.ca.gov''']<br>
 +
'''Preferred Provider Organization (PPO)'''<br>  
'''Preferred Provider Organization (PPO)'''<br>  
-
<p>A Preferred Provider Organization is basically a group of doctors who negotiate discounts with insurers. Unlike HMOs, there may be no restrictions on seeing specialists; however, members pay higher costs if they see non-PPO physicians. These plans are regulated by the '''Department of Insurance'''.</p><br>   
+
<p>A Preferred Provider Organization is basically a group of doctors who negotiate discounts with insurers. Unlike HMOs, there may be no restrictions on seeing specialists; however, members pay higher costs if they see non-PPO physicians. These plans are regulated by the '''Department of Managed Health Care'''.</p><br>   
 +
 
 +
'''<font color="#4AA02C">Department of Managed Health Care</font color="#4AA02C">'''<br>
 +
'''California HMO Help Center'''<br>
 +
7667 Folsom Boulevard, Suite 102<br>
 +
Sacramento, CA 95826<br>
 +
 
 +
'''Mailing address for complaints:'''<br>
 +
'''<font color="#4AA02C">California HMO Help Center</font color="#4AA02C">'''<br>
 +
980 Ninth Street, Suite 500<br>
 +
Sacramento, CA 95814-2725<br>
 +
(888) 466(HMO)-2219<br> 
 +
(877) 688-9891 TDD<br>
 +
(916) 229-0465 Fax<br>
 +
[http://www.hmohelp.ca.gov/ '''www.hmohelp.ca.gov''']<br>
 +
 
 +
<p>Assistance is available 24 hours per day, 7 days a week for consumers who need assistance with their HMO. Call center staff can assist consumers with a variety of issues including (but not limited to) quality of care, prescriptions, preventative testing, and information regarding the DMHC's complaint process.</p><br>
 +
 
 +
<p>'''Publications available:''' The California Patient's Guide: Your Health Care Rights and Remedies</p> 
   
   
      
      

Latest revision as of 21:39, 12 July 2013

729-Insurance

HEALTH BENEFITS PROGRAM (TYPES)

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Managed care health plans generally fall into three categories as follows:


Health Maintenance Organization (HMO)

Members are restricted to seeing HMO physicians. Usually, doctor visits outside the plan are not covered. The patient's primary physician will control patient access to specialists. Doctors may be employed by the HMO or practice independently. HMO's are regulated by the Department of Managed Health Care.


Department of Managed Health Care
California HMO Help Center
7667 Folsom Boulevard, Suite 102
Sacramento, CA 95826


Mailing address for complaints:
California HMO Help Center
980 Ninth Street, Suite 500
Sacramento, CA 95814-2725
(888) 466(HMO)-2219
(877) 688-9891 TDD
(916) 229-0465 Fax
www.hmohelp.ca.gov

Assistance is available 24 hours per day, 7 days a week for consumers who need assistance with their HMO. Call center staff can assist consumers with a variety of issues including (but not limited to) quality of care, prescriptions, preventative testing, and information regarding the DMHC's complaint process.


Publications available: The California Patient's Guide: Your Health Care Rights and Remedies

Point-of-Service (POS)

A Preferred Provider Organization is basically a group of doctors who negotiate discounts with insurers. Unlike HMO's, there may be no restrictions on seeing specialists; however, members pay higher costs if they see non-PPO physicians. These plans are regulated by the Department of Insurance.



Department of Insurance
Consumer Services Division
(800) 927-HELP (4357)(within California)
(213) 897-8921 (out of state)
300 South Spring Street, South Tower
Los Angeles, CA 90013
www.insurance.ca.gov

Preferred Provider Organization (PPO)

A Preferred Provider Organization is basically a group of doctors who negotiate discounts with insurers. Unlike HMOs, there may be no restrictions on seeing specialists; however, members pay higher costs if they see non-PPO physicians. These plans are regulated by the Department of Managed Health Care.


Department of Managed Health Care
California HMO Help Center
7667 Folsom Boulevard, Suite 102
Sacramento, CA 95826

Mailing address for complaints:
California HMO Help Center
980 Ninth Street, Suite 500
Sacramento, CA 95814-2725
(888) 466(HMO)-2219
(877) 688-9891 TDD
(916) 229-0465 Fax
www.hmohelp.ca.gov

Assistance is available 24 hours per day, 7 days a week for consumers who need assistance with their HMO. Call center staff can assist consumers with a variety of issues including (but not limited to) quality of care, prescriptions, preventative testing, and information regarding the DMHC's complaint process.


Publications available: The California Patient's Guide: Your Health Care Rights and Remedies



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