What are all the Acronyms?


By Rick Redalen, M.D.
2/22/2016

Below are some of the acronyms explained to help you in choosing your health plan

 

Preferred Provider Organization (PPO) – A PPO plan allows you to see a specialist without seeing your primary care provider first. This is called self-authorization. You may use in-network providers for your care which generally cost less, or providers not signed up with your network who generally carry higher out of pocket charges. Out of network providers will not usually provide all of the benefits your in-network providers do. You may also be balance billed which means you will pay the difference in cost your plan does not cover.  

 

Health Maintenance Organization (HMO) – An HMO plan is based on the concept of having a “gatekeeper.” The gatekeeper is your primary care physician who must give you a referral prior to seeing a specialist and also authorize that referral. The primary care physician is also a specialist. There are no out of network benefits except for emergency services and the HMO is not responsible for processing or paying claims outside of their network.

 

Exclusive Provider Organization (EPO) – An EPO plan is like a mixture of a PPO plan and an HMO plan. Like a PPO, an EPO plan member does not require authorization from a PCP to see a specialist.  However, like an HMO, an EPO plan member does not have out of network benefits, except for emergency services.

 

Hopefully this will help in the understanding of acronyms in an industry full of them.

The Meitiv Case – The Propagation of Police States


By Rick Redalen, M.D.
2/8/2016

This is a recycled blog topic that perhaps can use repeating so we all remain vigilant against our eroding rights and freedoms as citizens of this country.

I cannot resist saying a little bit more about the seeming propagation of our coming police state and the speed with which our country is heading toward a state of socialism.

I am sure many of you have seen the following story which has gained national attention. It was written by Candace Smith and Lauren Effron.

Maryland couple who was being investigated for allowing their two children to walk home alone from a neighborhood park have been “found responsible for unsubstantiated child neglect” by the state’s Child Protective Services.

Maryland Child Protective Services began investigating Danielle and Alexander Meitiv of Silver Spring, Maryland, for practicing so-called “free-range parenting,” a philosophy that encourages children to have some independence.

In the Meitivs’ case, this means they allow their two children, Rafi and Dvora, ages 10 and 6, to play outside and walk home by themselves.

Do any of you find this absolutely amazing? The Meitivs were “found responsible for unsubstantiated child neglect.” What on earth does this mean? According to Merriam-Webster, the definition of unsubstantiated means there is no basis in reason or fact. Unsubstantiated claims are thrown out of court. So with that reasoning, in this case the Meitivs were found responsible for nothing.

Where do we go from here? Do you think we can all use a little more government control? Don’t you worry that if the Maryland Child Protective Services are this much in need of work to “substantiate” a reason for their pay they will next be worrying about the “free range chickens”?

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