Decisions Faced by Nongovernment Payers of Healthcare: Managed Care

The concept of private indemnity insurance in healthcare refers to a fee-for-service plan where beneficiaries are compensated for their out-of-pocket costs, up to the limiting amount of the insurance policy. Unlike managed care organizations (MCOs), which overlay tools to control the utilization and cost of services, private indemnity insurance policies allow beneficiaries unrestricted provider choice and reimburse providers on a fee-for-service basis. Many indemnity plans are offered with deductibles, where the beneficiary will be required to pay copays (generally determined with percentages) for additional services required above the deductible amount.

When a private indemnity plan begins to control costs by restricting the choice of providers, it is typically referred to as an MCO. It is useful to think of MCOs on a continuum of loosely to ...