Spartanburg Radiological Associates

Types of Managed Care Insurance

Health Maintenance Organization (HMO)

• HMOs offer members a range of health benefits, including preventive care, for a set monthly fee.
• With some HMOs, you will pay nothing when you visit doctors; with others there may be a copayment for various services.
• An HMO plan usually covers only the cost of charges for doctors in that HMO. If you go outside the HMO, you will pay the bill.
• Generally, with an HMO, a patient will select a primary care doctor who will coordinate their care, including referring them to a specialist.

Preferred Provider Organization (PPO)

• A PPO has arrangements with doctors, hospitals and other providers of care who have agreed to accept predetermined fees from the insurer for their services.
• If you go to a doctor within the PPO network, you will pay a copayment (a set amount you pay for certain services-for example, $15 for a doctor or $10 for a prescription).
• If you go outside the PP0 network, you will have to meet the deductible and pay coinsurance based on in higher charges. You may also have to pay the difference between what the provider charges and what the plan will pay.

Point-of-Service (P0S) Plan

• Many HMOs offer an indemnity-type option known as a POS plan.
• In a POS plan, there are primary care doctors who make referrals to other providers in the plan. If the doctor makes a referral out of the network, the plan pays all or most of the bill.
• But, generally in a POS plan, members can refer themselves outside the plan and still get some coverage.

Check with your insurer regarding coverages and copayments.

Accepted Insurance Carriers

Carrier	Type Of Plan
Aetna	EPO / POS / PPO
Beech Street	PPO
Blue Cross Blue Shield of North Carolina Costwise MedPoint Preferred Care Select	Other
Blue Cross Blue Shield of South Carolina Preferred Blue PHS State Health Plan (SC State Employees, BCBS)	Other
Capp Care (under Beech Street)	PPO
Carolina Care Plan (formerly Physicians Health Plan)	EPO / POS / PPO
CIGNA	PPO / POS / HMO / Flex Care
Crescent	PPO
Southcare (formerly Ethix PPO)	PPO
Evolutions Healthcare	PPO
Hamrick�s	PPO
Health Care Savings	Other
Healthfirst "Options" Preferred PPO Signature HMO Options POS	PPO / HMO / POS
HealthSource	HMO / POS
PPO Next / Healthstar / HealthMark / PHN PPO	PPO / EPO
Inman Mills/ACMG	Other
Kanawha Preferred Solutions Preferred Benefit Solutions PPO Kanawha HMO Kanawha EPO/POS	PPO / EPO / POS / HMO
KEBA ABCO Industries Christman and Parson, Inc. SJWD Water District Spartanburg Water District	Other
MedCost American Healthcare Alliance	PPO
Medicaid	Other
Medicare
MPI/Southern Fine Banking	PPO
One Health Plan	PPO / POS
CCN/One Source (formerly THAN)	PPO
Opitmum Health Plan PPO for St Francis Employees	PPO
Patient First	PPO
Partners HMO of NC	HMO
PHCS John Alden PPO	PPO / POS
Physicians Care Network	Other
Premier Health Systems	PPO
Provident/Healthsource Preferred Network (PPO) Point of Service (POS)	PPO / POS
Prudential Healthcare PPO	PPO
Rutherford Health Plan	PPO
Spartanburg Advantage	PPO
Sunbelt Container/Tim-Bar	PPO
Synthetic Industries, Inc.	PPO
Unicare Life & Health/Metromont	PPO
WellPath	HMO
Regional Select SRHS Employess	HMO