What is Pittsburgh Health Insurance?

Pittsburgh Health insurance is a type of insurance that is specifically dedicated to address medical and health issues. It works with the insurer will pay the medical cost of the insured when they become sick or are injured. The coverage is dependent on what type of policy the insured party has.

Pittsburgh health insurance works with the cost of the health care being covered by the insurance company. For this to work the policy holder needs to pay a monthly premium which will then enable him to have access to various medical options, this is all dependent on the type of policy that he receives. If there is a need for health care services, then the insurance company should reimburse any fees paid.

Across America and also the state of Pennsylvania health care costs are sky rocketing.  This is mainly due to the cost of prescription drugs or new medical techniques that increase or make the quality of life better. The use of health insurance allows you to have reasonable health care coverage in the event you do become sick. Having no insurance and having to go to the doctor or a health facility can become quite costly or even unaffordable.

Pittsburgh Health Insurance Information

What Types of Pittsburgh Health Insurance Are Available
There are essentially two kinds of heath insurance: Fee-for-Service and Managed Care. Although these plans differ, they both cover an array of medical, surgical and hospital expenses. Most cover prescription drugs and some also offer dental coverage.

1. Fee-for-Service
   These plans generally assume that the medical professional will be paid a fee for each service provided to the patient. Patients are seen by a doctor of their choice and the claim is filed by either the medical provider or the patient.
2. Managed Care
   More than half of all Americans have some kind of managed-care plan. Various plans work differently and can include: health maintenance organizations (HM0s), preferred provider organizations (PPOs) and point-of-service (POS) plans. These plans provide comprehensive health services to their members and offer financial incentives to patients who use the providers in the plan.

Health Maintenance Organizations (HMO)
Pittsburgh health insurance has a managed care plan called HMO. The HMO or health maintenance organization is a plan that will provide an array of health care services to members of the network. In an HMO the members receive all their medical services such as doctor’s visits and prescription drugs from within the network. The members of the HMO are fully covered and their care is coordinated by a main physician.

The HMO has contracts with different health care providers which is called a private network. This private network will contain physicians and a large amount of other medical service professionals.

Members of the HMO can only receive medical services from within the provider network. If they do go outside of the HMOs network they will not get any benefits or will not be covered. This essentially means that members are tied to the HMOs network.

In Pittsburgh, the benefits of the HMO for the members are controlled by a Primary care Physician (PCP) or gatekeeper. This PCP is responsible for all aspects of the member’s medical care. They determine everything from recommending specific doctors to other medical services within the network. If the member needs to see a specialist that is outside of the network, then the PCP will refer the member.

The HMO is a very restrictive managed health care plan. The members of this plan are tied to the network and if they do decide to go outside they will not receive any benefits. The advantage of the HMO is the costs are very low as the purpose of the network is to provide cheaper options. The downfall of this type of plan is the fact to get any benefits they need to be within the network.

 

Preferred Provider Organizations (PPO)
PPO otherwise known as Preferred Provider Organizations is a type of managed care plan under Pittsburgh health insurance. This plan works where members are given achoice of using doctors and hospitals in a network and paying a copayment or using physicians and hospitals outside the network and being responsible for a paying an annual deductible and a percent of the bill for the visit.

The PPO is somewhat similar to an HMO in its workings, but it is also very different. The main difference is that with a PPO you are not required to use health care services within the private network. This means referrals or using doctors or all dependent on the individual. This gives an amount of freedom and more options for individuals. PPOs often use different tactics to ensure that the members use the services of its private network. This is done with lower costs being associated with using services within the network.

People in Pittsburgh, PA often choose the PPO because the restrictions are less compared to an HMO. They are free to essentially seek out health services that they want, while still have the benefits of having reduced costs if using providers within the network.

Point of Service (POS)

Pittsburgh health insurance has a managed care plan called Point of Service or POS. The POS works where subscribers to the private network are able to access providers and specialists within the private network. The member’s primary care physician or PCP will refer the individual to the health care specialist within the network.  The member is not committed to only the private network, he is able to go outside of the network to get the help that he needs.

Like an HMO the referrals are done by the PCP that was chosen in the network. As stated above the member does not have to use the PCP if it is looking for referrals for work done. They can go out of network, the only disadvantage with this is the fact that the costs will be higher and the benefits will be considerably lower. In this situation the responsibility will solely be on the member. They will need to have the proper paperwork filled out in order to get the proper reimbursements for their medical costs.

The costs mentioned above such as coinsurance, copays and deductibles will be higher if the member decides to use a practioner outside of the network.

The residents of Birmingham lean more towards the POS as their choice of managed care health plan. The main reason is it is much more relaxed compared to an HMO. They are not bound by the any specifics or any network.

List of Hospitals & Medical Centers in Pittsburgh, PA

• ALLEGHENY GENERAL HOSPITAL (320 EAST NORTH AVENUE)
  
  
• CHILDREN'S HOME OF PITTSBURGH (5618 KENTUCKY AVENUE)
  
  
• CHILDREN'S INSTITUTE (6301 NORTHUMBERLAND STREET)
  
  
• CHILDRENS HOSP OF PITTSBURGH (125 DESOTO ST)
  
  
• HEALTHSOUTH HARMARVILLE REHAB (PO BOX 11460, GUYS RUN ROAD)
  
  
• JEFFERSON REGIONAL MEDICAL CENTER (COAL VALLEY RD)
  
  
• LIFECARE HOSPITALS OF PITTSBURGH INC (225 PENN AVENUE)
  
  
• MAGEE WOMENS HOSP OF THE UPMC HELTH SY (300 HALKET STREET)
  
  
• MERCY HOSPITAL OF PITTSBURGH (1400 LOCUST STREET)
  
  
• MERCY PROVIDENCE HOSPITAL, INC (1004 ARCH ST)
  
  
• SELECT SPECIALTY HOSPITAL O PITTSBURGH (1400 LOCUST STREET)
  
  
• ST CLAIR MEMORIAL HOSPITAL (1000 BOWER HILL ROAD)
  
  
• SUBURBAN GENERAL HOSPITAL (100 SOUTH JACKSON AVENUE)
  
  
• UPMC PASSAVANT (9100 BABCOCK BOULEVARD)
  
  
• UPMC REHABILITATION HOSPITAL (1405 SHADY AVENUE)
  
  
• UPMC SHADYSIDE (5230 CENTRE AVE)
  
  
• UPMC SOUTH SIDE (2000 MARY STREET)
  
  
• UPMC ST MARGARET (815 FREEPORT ROAD)
  
  
• UPMC, PRESBYTERIAN (200 LOTHROP STREET)
  
  
•  WESTERN PENNSYLVANIA HOSPITAL (4800 FRIENDSHIP AVE)