What Is An IPA For Health Insurance?

By Robert Fredricks Posted in Health Insurance News

An IPA is a group of physician¬† and other types of health care providers that are contracted to care for patients with HMO’s and other type of insurance plans. For example, the Dupage Medical Group located in Naperville, Illinois consists of one hundred doctors with various specialties and several hospitals. There are primary care physicians, internists and family doctors, renal specialists, pulmonologists, cardiologists, and many other types of physicians all associated with this medical group. This group is contracted with various HMOs and PPOs to see the patients that belong to that insurance group.

What This Means For The Consumer

Solo practitioners, doctors who are in practice by themselves, can also enter into a contract with insurance companies. Basically, what the physician groups are doing when they sign up to accept a certain type of insurance is agreeing to a pay schedule. A pay schedule is a predetermined fee paid for services through the insurance company. For example, if a patient comes in to see their doctor for the flu, their insurance company will agree to pay a set amount for that visit, say $100.

One benefit is that it keeps insurance costs down. However, one of the downfalls is that doctors may be reluctant to perform certain tests or procedures because of the low rate of reimbursement. This problem is endemic and not easily fixed with higher fees. The overall cost of health care would need to be regulated in order for this to change.

What Will Change

Not much will change in the current system with the proposed health care overhaul. The only difference would be the availability of health insurance to the general public. But any government run health care plan would have the same kind of contracts with doctors that would pay in fee schedules. Many times this type of payout deters doctors from accepting certain kinds of insurance in turn limiting the number of physicians available to you through your insurance provider.

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  5. What Is PPO Health Insurance Coverage?

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