These terms became part of our vocabulary during the last decade. Sometimes the use of these words seems to make an already-confusing situation even more confusing.

At Cedars-Sinai Medical Network, we take the
role of educating our patients seriously, and education extends beyond telling you what pill to take and at what time, or what changes your body will go through during pregnancy. We want to make the total healthcare experience as painless as possible - which includes helping you understand how healthcare works in Southern California today.

The idea of managed care began as a reaction
to the increasing costs of providing medical care in the United States. As early as 1973, the United States Congress passed The HMO Act, which funded some of the first health maintenance organizations (HMOs) that have evolved into today's managed care system. At that time leaders wanted to create a structure that rewarded physicians for providing high-quality care but that kept them from ordering extra tests that added unnecessary costs. The idea was for the system to focus on preventive care - care that would keep you from going into the hospital or nursing home - not just to react when you became ill or injured.

People using managed care to pay for their
healthcare have signed up with an insurance
company using a type of insurance that restricts how care is delivered. The term "managed care" means that the insurance company is taking responsibility for keeping the cost of providing care low while keeping the quality of care high.

If you signed up for healthcare benefits through your employer, you may have been given a choice of insurance companies, such as Aetna, Blue Cross, CIGNA, HealthNet or PacifiCare. Each of these companies has different managed care plans (sometimes called products), such as HMO, PPO referred provider organization) or POS (point of service).

Using the basic definition, an HMO plan means you must choose a primary care physician, and you must use the physicians who are contracted with that group and HMO for any care. If you do not, the HMO will not pay for the care.

Under managed care, you typically pay a small amount each time you see the physician, usually a $10 or $15 co-payment. These fees vary based on your insurance plan.

Under a PPO plan , the insurance company will give you a list of physicians you can see and still be covered, so you have more leeway in selecting a physician. If you see a physician outside that list, the insurance company may pay for some of the care but will usually require you to pay a larger amount.

Under a POS plan , you have an HMO with a PPO option. When you need care, you choose to activate either the HMO or PPO option. The HMO and PPO options pay for different amounts - usually the HMO option covers more care, but you are more restricted to the
physicians from which to choose.

While we cannot tell you to choose one plan
over another, we can tell you it is important for you to consider various factors in making your
choice, such as:

• How much you can afford to pay out of pocket
• Whether your current physician is part of one plan but not another
• How often you or your family need medical care

Your insurance company will ask you to choose a primary care physician - usually a general internist or family practice physician - who will direct your care. At Cedars-Sinai Medical Group and Cedars-Sinai Health Associates, all of our primary care physicians are board certified internists or pediatricians who diagnose and treat a variety of illnesses and injuries, and assess the types of specialized care you might need. In most cases, your primary care physician (often called your PCP) can care for most of your needs.

If you use an HMO or PPO plan and need to see a specialist - such as an orthopedist, neurologist or cardiologist - your primary care physician will request a referral (or authorization) from the Utilization Management Department. This referral indicates to the insurance company that
you have gone through the correct procedures for getting specialized care. At Cedars-Sinai Medical Group and Cedars-Sinai Health Associates, most of our referrals are automatic (or pre-approved), meaning they are given to you at the primary care physician's office and do not need further review.

In most cases, your referral will be automatic and you will have it with you when you leave your physician's office. This allows you to make an appointment with a specialist quickly.

Individuals who prefer unlimited choices of physicians, who do not want to deal with the restrictions of managed care or who do not have healthcare coverage typically pay cash for their services. This is called fee-for-service. Sometimes an individual
pays fee-for-service but has insurance and
requests refunds from the insurer after seeing the physician. This is only possible with certain types of insurance. People paying fee-for-service can see any physician without a referral.

Medicare is a government-run program to pay for healthcare for individuals meeting certain criteria. Many people think that Medicare is for people over 65, but it also pays for healthcare of people with end-stage renal disease or certain disabilities. Medicare has two ways of paying for healthcare - HMOs (managed care) or fee-for-service (Parts A and B).

For more information on Medicare and how it
works, visit the Medicare website sponsored by the Health Care Financing Administration) at www.hcfa.gov, or visit your local Social Security
office.

Cedars-Sinai Medical Network strives to make
your healthcare experience as pleasant as possible - both clinically and administratively. We understand the frustrations of dealing with insurance companies when you or someone you
love is in need of medical care. We also know that coming in for a routine physical should not be a hassle. We want to be part of your support network and provide the highest quality care that meets your needs.

Cedars-Sinai Medical Network provides medical care in two ways, with each serving a unique need in response to today's healthcare environment.

• Cedars-Sinai Medical Group - a medical group
• Cedars-Sinai Health Associates - an independent physician organization

Cedars-Sinai Medical Group (CSMG)
comprises about 60 physicians who have created a company and are employees of the group. The group primarily includes internists, as well as specialists that include dermatologists, endocrinologists,
gastroenterologists, general surgeons,
obstetricians, gynecologists, hand surgeons,
pediatricians, plastic surgeons, rheumatologists and others. Therefore if you need a specialist, you can often see one affiliated with Cedars-Sinai
Medical Group.

The physicians at CSMG accept most forms of
payment, including fee-for-service and managed care plans. Our offices are designed to serve all patients, regardless of how they pay.

Cedars-Sinai Health Associates (CSHA)
comprises physicians who work together to
provide care for managed care patients. These physicians are not employees of a group. Rather, they maintain independent offices (thus, the term "independent physician association") and see other patients not associated with managed care or CSHA. People who sign up with a CSHA
doctor are members of a managed care plan.

Our physicians provide the same high-quality, compassionate care no matter how you pay. The only difference is in the paperwork.

• If you are a fee-for-service patient, you can find the physician you want to see, and call for an appointment.
• If you are in a managed care plan and have already chosen a primary care physician with CSMG or CSHA, you can also call that physician for an appointment.

We wish we could predict what will happen to
healthcare during the next decade, or even the next year. Change is certainly underway, and our expert administrative team is analyzing what those changes might mean. Still with all these changes, we are certain of one thing: Cedars-Sinai physicians care for you.

If you are new to the Cedars-Sinai Medical
Network, we suggest you call our Member
Services Department. Our representatives will work with you to find a physician who meets your needs.

CSMG Member Services: (800) 700-6424
CSHA Member Services: (800) 773-2742