Lamont has a point-of-service plan and is seeking to obtain health services outside the network. What will likely be the end result?

Lamont has a point-of-service plan and is seeking to obtain health services outside the network. What will likely be the end result?

• A. Lower copayments
• B. Higher out-of-pocket costs
• C. Immediate access to specialists
• D. No additional costs

Answer: (B)

In a point-of-service (POS) plan, members typically have the flexibility to choose between receiving care from in-network or out-of-network providers. However, this choice comes with differences in cost. When Lamont seeks health services outside of the network, he is likely to incur higher out-of-pocket costs. This is because POS plans generally offer lower copayments and coinsurance rates for in-network services, incentivizing members to use preferred providers. Conversely, when seeking care outside the network, Lamont would typically face increased copayments, higher deductibles, and overall greater financial responsibility. This is designed to encourage patients to utilize services provided within the established network where costs are kept lower for both the insurance company and the policyholder. Therefore, the end result of obtaining services outside the network aligns with increased financial burdens for the insured individual.

In a point-of-service (POS) plan, members typically have the flexibility to choose between receiving care from in-network or out-of-network providers. However, this choice comes with differences in cost. When Lamont seeks health services outside of the network, he is likely to incur higher out-of-pocket costs.

This is because POS plans generally offer lower copayments and coinsurance rates for in-network services, incentivizing members to use preferred providers. Conversely, when seeking care outside the network, Lamont would typically face increased copayments, higher deductibles, and overall greater financial responsibility. This is designed to encourage patients to utilize services provided within the established network where costs are kept lower for both the insurance company and the policyholder. Therefore, the end result of obtaining services outside the network aligns with increased financial burdens for the insured individual.