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The most obvious difference between HMOs and PPOs is that members aren't required to work through a PCP in order to get referrals. In addition, members aren't limited to care from PPO physicians; they're free to go outside the PPO group. Like POSs, there is a deductible if you go outside the network. Additional benefits include not having to get referrals before going to a specialist and not worrying about being "out of network" in the event of an emergency illness or injury when traveling. Any specialist you see must work within the HMO network, otherwise you'll pay for the visit yourself. Drawbacks of PPOs include higher fees for those doctor's outside of the network, which at times can be substantial. But, when going outside the network you'll usually have to pay a deductible (around $300 for an individual) as well co-insurance (usually 30 to 40 percent) as you do with FFS plans. Recently some FFS plans have begun operating more like managed care plans. FFS plans are typically more versatile than other types of plans. Some plans will cover drugs both on the formulary, which are referred to as "preferred" drugs and usually include generic drugs, and drugs not found on the formulary, or "nonpreferred" drugs usually including brand-name drugs.

The basis of any insurance plan's prescription benefits is a formulary, which is a list of all the drugs your insurance company is willing to pay for. Because costs for procedures vary among geographic areas, what your doctor charges for a procedure may not be what your insurance company is willing to pay. For plans that cover prescription drugs, there may be requirements for specific drugs (such as generic vs. Many insurance plans have excluded high-cost drugs from coverage, cut down on the amount of refills and increased co-pays. A formulary can be used in several different ways depending on your exact insurance plan. Other insurance plans may be more cut and dry, covering only those drugs on the formulary and denying payment for any drug not on the formulary without some sort of pre-approval process. Today, prescription drug spending is still rising, but the rise can now be measured in single digits. From 1994 to 2003, prescription drug costs rose at double-digit rates each year. This slow-down in spending is attributed to a few changes in the world of prescription medication including the way health insurance companies offer prescription drugs to their users.

The insurance company may reimburse you for 100 percent of care obtained from network physicians, but will only reimburse you 80 percent for non-network treatment. It may seem like an oversimplification to say that exercise can prevent a heart attack. Deductibles are usually around $250 for an individual, but they can be as high as $10,000. The drawbacks of HMOs are fewer choices in doctors and facilities, as well as having to go through a primary physician in order to see specialists. Being able to go to any physician is a big part of that versatility. While the mechanism behind this finding is unknown, it does agree with Hain's theory about the brain being the problem, not the inner ear. Deep within yourself, your soul is behind every move and every decision you make. You're required to select one doctor from the organization's network as your primary care physician (PCP). You have no deductible when seeing a physician within the network and will pay a small co-pay (around $10) for each office visit. You're also allowed to self-refer to other physicians (including specialists) within the network.

HMOs can have their own medical facilities and staff, or the HMO can contract with outside physician groups or individual doctors. If you want to go to a physician outside the network, you're free to do so without consulting your primary care physician. However, if you choose to go outside the network, you're in charge of all paper work needed in order to get reimbursed for the expenses. An additional benefit of the PPO, however, is that there's a maximum on out-of-pocket expenses. But your insurance company says the maximum allowable charge for a tonsillectomy is $300, which means you really owe $110 (20 percent of $300, plus the extra $50 your doctor charged above what the insurance company will pay). At this point you may have to get insurance through a different company. For some policies there may be a cap for the year or for a specific illness claim. Some experts, like Marlene Dobkin de Rios, Ph.D., who wrote the 2002 paper, "What We Can Learn From Shamanic Healing: Brief Psychotherapy With Latino Immigrant Clients," published in the American Journal of Public Health, believe that the personal empowerment, behavior modification and cognitive restructuring encouraged by some shamans may be helpful for some people coping with physical, emotional or psychological issues.

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