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Texas Health Insurance - Indemnity And Managed Care

Health insurance in Texas is broken into two major categories - indemnity and managed care. Both individuals and employers must understand the difference between the two and make choices regarding which offers the best coverage at the most reasonable price.
For complete control over your health provider choices, indemnity insurance is your best option. You can choose any doctor you want to see and there no provider networks limiting choice. The downside of an indemnity plan is that you incur more up-front costs and have higher premiums than other health insurance in Texas. However, you may find you enjoy the freedom offered by the indemnity insurance model enough to choose the higher out-of-pocket expense.
Managed care offers less flexibility but a more affordable choice for health insurance in Texas. These insurers work with a specific network of doctors and providers who agree to certain fee structures to help manage costs. Because of this, there is less choice than with indemnity insurance but the cost differential is significant enough to make it a great choice for many people.
There are multiple insurance companies who offer indemnity plans to both individuals and to employers. What makes an indemnity plan unique is that the patient is responsible for payment of all medical services at the time they are rendered. They then file claims with the insurer to be reimbursed for their treatment. Indemnity plans rely heavily on patients to make wise and frugal choices with regard to their healthcare and only use their insurance when necessary.
On the other side of health insurance in Texas, more people are going to managed care because of the costs associated with indemnity coverage. This health insurance coverage does cost less than indemnity coverage and will cover some of the same medical services. Managed care costs less because they are able to work directly with doctors and medical facilities to offer services to policyholders at rates that have been hammered out between them. People are now starting to prefer the lower cost over the limited options, as rising costs have become a concern for many.
Managed care health insurance companies in Texas are also known as HMO’s (Health Maintenance Organizations). They require their members to choose doctors and hospitals within their network because these are the doctors and hospitals that have agreed to their terms. Only under emergency conditions is a member allowed to use a hospital or doctor outside of the network and in those cases the patient will be billed the difference between what that hospital charged them and what the managed care plan is willing to pay. This information is listed in your policy agreement and you should be sure you read and understand it before attempting to make a claim.
An HMO is also different in that members must choose a primary care physician (PCP) from their insurers network. Patients see their PCP’s for all of their medical needs and, if a referral is required, that the patient only sees other doctors within the network. The high level of patient cost monitoring and management is why these plans are called “managed care” plans. While this is the most affordable health insurance in Texas, it is important that you read your policy carefully and understand its limits and guidelines so you can get the best healthcare you can while not incurring additional costs.