Initial Health Assessment process in HMO

Initial Health Assessment

As a Medicare Advantage Organization, BCBSF must make a reasonable effort to complete an initial health assessment for each BlueMedicare HMO, BlueMedicare PPO and BlueMedicare PFFS member within 90 days of enrollment to identify members with potential serious and/or complex medical conditions. BCBSF will notify the member’s in-network primary physician if:

* The member refuses the assessment.

* The member is placed in the high-risk category and the member consents to the release of the results.

comparison of HMO, PPO, POS, EPO

HMO:

Need a referral from PCP to see a specialist.

Need to select a PCP with in network

Low premium

Dose not covered the out of network service

PPO:

Don’t need a referral from PCP to see a specialist.

Don’t necessary have to choose a PCP

High premium

dose cover the out of network