Table of Contents
BASICS OF MANAGED CARE
Funded by a grant from the federal
Maternal and Child Health Bureau, Department of Health and Human Services
Administration (#MCJ-17R804-01)
Quality Community Managed Care
Moderator - Faye Manastar Eldar,
MEd
Karen Gugliuzza
Lynn Doolittle
Early Intervention
Child and Family Connections
What is managed care?
What does manage care “manage”?
What is a Health Maintenance
Organization? (HMO)
What is a Point of Service Plan?
(POS)
Point of Service
What is a Preferred Provider
Organization? (PPO)
Preferred Provider Organizations
What is Traditional Insurance?
Traditional Insurance
Traditional Insurance
Capitation
What are covered benefits?
Read your insurance plan or
booklet. Look for:
Look for:
Resource for families
Family Voices
What is a referral?
Another view of a referral
About referrals
More about referrals
Out-of network referrals
How to find out what is covered?
How do I find out what is covered?
Referrals and families
How long do referrals last?
What are the Benefits of Managed
Care?
Benefits of Managed Care
More Benefits
What are the Challenges of a
MCO?
Challenges
Challenges
Referrals
How are decisions made?
How are decisions made?
Who makes decisions?
What is an appeal?
How do you appeal?
How to learn about appeals
What we all need to do:
Thank you for joining us for
our first webcast.
For further information on managed
care, return to our website and click on resources. http://www.uic.edu/sph/cade/kidsmco
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