If a patient cannot see a non-network doctor because the doctor is not on the approved providers list, this indicates the patient is in what type of plan?

If a patient cannot see a non-network doctor because the doctor is not on the approved providers list, this indicates the patient is in what type of plan?

• A. PPO
• B. POS
• C. HMO
• D. EPO

Answer: (C)

Network restrictions and gatekeeping are at play here. In an HMO, you typically must use in-network providers, and visits to doctors outside that network aren’t covered (except in emergencies). You usually have a primary care physician who coordinates care and referrals to specialists, which keeps care within a fixed network. That’s why not being able to see a non-network doctor on the approved list points to this type of plan. By contrast, other plans often allow at least some out-of-network care (usually with higher costs or limited coverage), so they wouldn’t align as cleanly with the scenario.

Network restrictions and gatekeeping are at play here. In an HMO, you typically must use in-network providers, and visits to doctors outside that network aren’t covered (except in emergencies). You usually have a primary care physician who coordinates care and referrals to specialists, which keeps care within a fixed network. That’s why not being able to see a non-network doctor on the approved list points to this type of plan. By contrast, other plans often allow at least some out-of-network care (usually with higher costs or limited coverage), so they wouldn’t align as cleanly with the scenario.