PSNs may act like a full-fledged HMO by selling services as a health insurer to whom?

PSNs may act like a full-fledged HMO by selling services as a health insurer to whom?

• A. PSNs/PSOs may act like a full-service HMO, selling their services as a full-service health insurer to businesses and individuals.
• B. PSNs only provide emergency services and cannot sell insurance.
• C. PSNs are restricted to government contracts.
• D. PSNs are a type of hospital network only.

Answer: (A)

Managed care plans operate by providing a wide range of covered services to enrolled members through a network, in exchange for a prepaid or contracted payment. When a PSN functions as a full-service health insurer, it offers and sells that coverage directly to groups and individuals, arranging contracts with businesses to provide employee benefits and offering plans to individuals seeking coverage. This payer role explains why a PSN can act like an HMO, coordinating care and bearing risk across a broad member base. The other ideas—restricting PSNs to emergency services, limiting them to government contracts, or viewing them only as a hospital network—do not fit the model of a comprehensive insurer that contracts with employers and individuals to provide ongoing, prepaid access to a full suite of services.

Managed care plans operate by providing a wide range of covered services to enrolled members through a network, in exchange for a prepaid or contracted payment. When a PSN functions as a full-service health insurer, it offers and sells that coverage directly to groups and individuals, arranging contracts with businesses to provide employee benefits and offering plans to individuals seeking coverage. This payer role explains why a PSN can act like an HMO, coordinating care and bearing risk across a broad member base.

The other ideas—restricting PSNs to emergency services, limiting them to government contracts, or viewing them only as a hospital network—do not fit the model of a comprehensive insurer that contracts with employers and individuals to provide ongoing, prepaid access to a full suite of services.