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What a traditional indemnity plan actually pays for
Fee-for-service, no primary-care gatekeeper, no referral to see a specialist. Here is what that means in practice, before you ever open a claim.
Chapter 01
Fee-for-service, not a network you have to live inside
A traditional indemnity plan is a fee-for-service plan. It does not force you to pick a primary care doctor, and it does not route every visit through one gatekeeper before anything else can happen.
You do not need a referral to see a specialist. If you want to see one, you self-refer. There is no waiting on a primary care doctor's office to send a form along first.
An open manila folder lying face down on a dining table beside a calculator.
UCR and the deductible, the two numbers that decide what you pay
Because an indemnity plan is self-managed rather than run through a negotiated network, it pays claims against the UCR rate, Usual, Customary and Reasonable, for the area and the service. There are no network-negotiated rates sitting behind the number.
A deductible applies before benefits pay out. Once it is met, the plan pays against the UCR rate for the covered service, the way it is built to.
Chapter 03
No geographic restriction on who you see
There is no geographic restriction on your choice of doctor, specialist or hospital. An HMO or a PPO limits you to a defined service area or a contracted list. An indemnity plan does not work that way.
That is the trade you are making: a plan built around freedom of choice, priced against a published rate rather than a network discount.
Private medical insurance for the Media, PA area
Mike Garvey's office sits at 361 Paxon Hollow Rd in Media, Delaware County, and private medical insurance is written from there for families and small businesses across the surrounding area.
The brokerage is licensed to write coverage across Pennsylvania, Delaware, Maryland, Indiana, Kentucky, Kansas and Missouri, so a plan set up in Media carries the same way if you move within that footprint or run a business across state lines.
Pro Health Plans. Pro Health Plans is owned and operated by a group of licensed, independent insurance agents who have met the financial and ethical standards set by New Era - Philadelphia American Life Insurance Company. Pro Health Plans has also completed the licensing standards set by each state in which we engage the insurance business. Call (610) 529-1106.