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Few Seem To Use POS Option To Go Out of Network

The popularity of loosely controlled benefit plans comes at the expense of HMO enrollment, which fell by more than 700,000 — about 1 percent — from July 1, 1999 to July 1, 2000. InterStudy Publications says HMO enrollment peaked at 80.8 million in July 1999.

The heaviest losses came in the Southeast, where 928,000 people streamed out of HMOs — a 7 percent decline. This was offset by a 4 percent gain in Pacific states, where HMOs gathered 890,000 new enrollees.

Point-of-service plans, in which members can see an out-of-network provider for higher out-of-pocket cost, are among the options employers offer with increasing frequency. Interestingly, while these plans have been gaining popularity, relatively few who enroll in them appear to take advantage of the out-of-network option. An examination of three POS plans in the Journal of the American Medical Association, found that only 4 to 7 percent of enrollees referred themselves to out-of-network specialists. Those who did tended to be sicker, with unstable chronic conditions.

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