A client asks the nurse to explain the difference between an HMO and a PPO. What should the nurse include when responding to the client?
1. "You'll have good health care benefits, so don't worry."
2. "Both the HMO and PPO are covered by your employer, so it's really not your concern."
3. "Your PPO offered you a choice in your health care provider as well as services. Now, you will choose a primary care provider who will evaluate your health and will coordinate all of your care."
4. "You really should be happy about the HMO. You'll pay little, if any, out-of-pocket expense."
Correct Answer: 3
Rationale 1: Telling the client not to worry does not address the client's question, which is to explain the difference.
Rationale 2: Telling the client not to worry does not address the client's question, which is to explain the difference.
Rationale 3: HMO plans emphasize wellness, and members choose a primary care provider who evaluates their health status and coordinates their care. Clients are limited in their ability to select health care providers and services, but available services are at minimal and predetermined cost to the client. PPOs consist of a group of physicians that provide an insurance company or employer with health services at a discounted rate. One advantage of the PPO is that it provides clients with a choice of health care providers and services.
Rationale 4: Even though telling the client that she will have little out-of-pocket expense may be truthful, it doesn't answer the question.
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