What Is An IPA Insurance? Benefits Of Selecting IPA For Your Insurance Plan  

Helen Skeates
Helen Skeates
23 min read

Are you planning to purchase health insurance and looking for the answers to what is an IPA insurance? Or, by any chance, are you a health care provider who is looking for the pros and cons of IPA insurance? In either case, you are on the right page. In this article, we will discuss all the components of health issuance including, the IPA insurance.

The primary step while purchasing health care insurance is selecting the plan. After that, you can decide either to visit a general physician or clinic or a hospital. Before purchasing your health insurance plan, you must study all the elements in detail.

While selecting your health insurance plan, you should analyze the monthly charges of the insurance plan and the additional expense of health care which includes specific health care needs. Also, make it clear that either you will or will not require your family doctor.

What is an IPA?

Independent physician associations, also known as independent practitioner associations, are created by groups of doctors that join together to contract with Health Maintenance Organizations (HMOs), Accountable Care Organizations (ACOs), and Management Care Organizations (MCOs).

Medical practices that want to give quality care but need additional resources and experience to be at the forefront of value-based care are attracted to an IPA. IPAs allow providers to participate in risk contracts even if they lack administrative resources to do so.

It can involve collaboration among primary care physicians, other specialties, or both. They can also cover a defined local area (most common) or several geographical regions. An IPA may also organize as a Clinically Integrated Network (CIN) to improve patient care, decrease healthcare costs, and adapt to the value-based market.

What Is A Health Maintenance Organization?

HMO is a legally established organization of health insurers that arrange healthcare facilities for physicians’ insurance holders and another HMO-approved practitioner. They offer essential and premium medical care for the members.

What Is An IPA Insurance? Complete Guide For Health Insurance Plan - Krostrade

The partnerships between general practitioners, clinical, and hospitals assist the company by maintaining its team of healthcare professionals.

Healthcare institutions that make deals with the HMO get compensated for providing several benefits to them.   The organization administers health insurance for monthly or yearly charges. This health management insurance confines customer access to medical treatment supplied by a licensed community of clinicians or from other healthcare sources.

The charges for this type of insurance are reduced than that of standard health insurance because the patient is referred to healthcare practitioners under contract with the company. HMO has several kinds, one of which is IPA.

What Is IPA Insurance?

What is an IPA insurance? The IPA is a category of HMO (Health maintenance organization) in which licensed medical practitioners, mainly doctors, form a partnership by signing a contract. The physicians then collaborate with third parties or insurance companies. The term IPA is an abbreviation of independent practice association.

The contract between them allows health care providers to examine the patients registered under HMO and their regular clinic patients. The IPA partnership increases the patients’ patient flow as they receive additional patients through references of either third party or insurance company.

Health care professionals in this partnership are paid by the affiliated partner of the insurance company network according to each patient the doctor treats. Compensation to the doctors by insurance companies can also be in the form of reduced cost of the insurance plan, or the company will cover the doctor’s health insurance plan that they offer.

This partnership gives an advantage to both the doctor and the company as well. Thus, the doctors earn by checking more patients and company profits by saving money from medical bills in case of any health insurance claim.

The insurance companies are benefited from this cooperation as they can transfer their insurance holders to the doctors in the network that will cost them less than the off-system doctors. The fee of the treatment with the in-system doctors is, discussed before taking them in partnership.

If you are an IPA doctor, your patients will benefit from this by showing your IPA registered number, which will make the insurance plan charges go down. Learn more about IPA by reading this article, “What is IPA?”

Benefits Of Selecting IPA For Your Insurance Plan  

Health care professionals with IPA insurance have greater independence than the doctors working for particular hospitals or organizations. The doctors under IPA have the freedom to do whatever is appropriate for the patient but, for payment, the physicians are a member of the organizations. But this service patient’s health is a priority and not making the health care facility famous.

This service implies that you will receive specific treatment according to the requirement. According to this plan, health care providers have the authority to prescribe you any drug according to your need, and as well as they can recommend you to any physician. On the other hand, now that you know the benefits, you might want to read “How much do you pay for health insurance?” which will help you out.

What Is An Indemnity Insurance Plan? 

It is generally known as a fee-for-service plan. This method lets individuals control their medical services and, they are free to visit any physician they want or get treated at any hospital they wish to. The insurance provider then covers the pre-discussed amount of your total expense.

Some medical procedures might demand patients to be paid in advance. You can later submit the claim to your insurance company for reimbursement. This plan is relatively costly than the other insurance plans as it gives consumers the liberty of selecting their physician. The indemnity plan is for individuals who are willing to pay a little extra for their health care services.

How does an IPA Work?

HMOs or other managed care plans contract with IPAs, and those IPAs in turn contract with independent healthcare providers to provide members with care at a discount or a uniform fee.

In its traditional form, an IPA includes all specialties. Still, an IPA can be exclusively for primary care, could consist of one type of service, or could involve a group of providers of other benefits as well, such as food banks, homeless shelters, and substance abuse treatment centers.

Since IPAs are self-supporting entities and are not involved with large medical corporations, physicians have full authority to their own offices and practices.

The practitioner can tend to patients inside or outside an affiliated health maintenance organization (HMO). Healthcare providers receive compensation based on a per-patient fee schedule or discounted fee schedule. Therefore, regardless of how many times their patients go in, they still get paid.

The IPA and HMO contract defines the responsibilities of the IPA as it pertains to complying with government and industry regulations and allowing patients to access physicians. Each physician has a similar agreement with the IPA. In the absence of these contracts, IPA physicians will not receive payment for services provided to HMO patients.

IPAs are not allowed to negotiate with insurance companies on behalf of providers’ other insurance reimbursements under the Federal Trade Commission Act despite a perception that they have established to improve compensation rates. IPA can only negotiate for members for services contracted on a capitation basis.

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Benefits of IPA

The following are some benefits possible from properly functioning IPAs:

  • A well-developed ability to negotiate effectively and efficiently with payer organizations and health insurance companies to reduce each member’s or patient’s annual premiums
  • Expanding services include extended hours, urgent care, prevention outreach programs, triage by phone, and follow-up expertise.
  • An integrated approach to managing healthcare records and preventing discrepancies and errors
  • Maximizing administrative and management facilities and technologies
  • The capability to easily step into the role of responsible care organizations (ACOs) when needed


As well as IPA benefits, there are potential drawbacks. Being a member of an IPA will not remove a care provider from their duties as an administrator within a medical practice.

Some IPAs may also not be run efficiently due to rapid growth, low levels of management experience, or rapid changes in technology.

Additionally, IPAs can encounter antitrust concerns since they represent competing healthcare providers.

Guidelines for IPAs

Practitioners considering establishing or participating in an IPA should study the following principles:

  • The IPA should implement a health care delivery system that delivers improved patient health outcomes.
  • To provide patients with optimal care, promote the success of an IPA, and boost physician satisfaction, it is crucial to effectively manage relationships between primary care physicians, limited specialists, and hospitals.
  • Physician-patient relationships are unique and should be maintained.
  • Health care delivery should be efficient and effective to provide value for patients. These improved care efficiency and productivity should result in financial benefits for healthcare providers.
  • Physicians in the network must be autonomous and accountable to maximize the benefits of an IPA.
  • Participating physicians in IPAs must carefully consider physician equity when maintaining desired degrees of control and autonomy. Incorporating these principles into IPA vision and mission statements may be helpful for physician education.

Although IPAs can help manage costs and improve care, they are not a panacea for the medical system. As they have advantages, so do they have disadvantages.

Medical Group vs. IPA

An Independent Practice Association is an organization of physicians established to contract with third party payers. Not every doctor wants to sell their practice to a hospital or larger practice. An IPA allows physicians who aren’t one, combined corporate entity, to enjoy the benefits of a larger organization. They don’t have a legal relationship with one another, they remain independent practices.

A medical group is collection of doctors who have partnered with one another, contractually. The purpose of this partnership is to share the care of patients. They are considered one legal entity and can contract with third party payers.

How to Choose a Medical Group

How you choose your medical group will depend on whether or not you already have a primary care physician (PCP). If you do have a PCP that you trust, you’ll just go with the group your doctor is associated with. If you don’t have a primary care physician yet, here’s a few questions to ask yourself.

  • Is the medical group a part of the health plan you’ve chosen?
  • Is there a primary care physician within the group in your area?
  • Do the group have specialists you might need access to?
  • Which hospitals have relationships with the doctors in the medical group?
  • Does the group have diagnostic services?
  • Is there a proper system for referrals and coordination of other medical information between the doctors?
  • Are physicians in the medical group Board Certified or Board Eligible?
  • Does the medical group offer online services?

Why Choose an Independent Practice Association?

Physicians who are a part of an independent practice association have more freedom than doctors in a specific medical group. That’s because they’re independent and can do what’s best for the patient. They’re part of the group for billing purposes. When it comes to services, they are free to do what’s best for their patients.

This means you get more personal service, unique to your needs. Doctors can prescribe any medication and refer you to any other doctor. Their focus is your health, not the restrictions of an overarching medical group. Therefore, your PCP can perform or recommend any test or treatment they feel is necessary for your health care.

Your first step is to choose your healthcare plan. Then you can worry about determining which primary care physician and medical group or independent practice association you should choose. More times than not, individuals choose their doctors and let that dictate the medical group. But if you’d like to know everything about your healthcare plan, the doctor, and the medical group, discover the answers to these questions.


Who can join IPA?

Anyone with HMO insurance can and need to join an IPA.

How do I become an Allied Pacific member?

To join Allied Pacific IPA, Please refer to (How to join Allied Pacific IPA) page. For more inquiries, please call 626-282-0288 and speak with one of our customer service representatives.

Where is Allied Pacific member service center located at?

Allied Pacific IPA continue to provide quality service to members. The member service center is located at 568 W. Garvey Ave, Monterey Park, CA 91754 and 18575 Gale Ave, City of Industry, CA 91748. We welcome any walk-in members Monday to Friday 8:30am-5pm. For more inquiries, please call 626-282-0288.

What is my copay?

Copay, or copayment is a payment defined in the insurance policy and paid by the insured person each time a medical service is accessed. A member’s copayment varies depending on the type of insurance they have. Please contact your Insurance carrier for copayment information.

How do I choose or change my family doctor?

Family doctor is commonly refer as PCP (Primary Care Physicians). When enroll into a HMO plan, you need to choose a designated PCP within the IPA network. For our network of contracted PCP, please click here. If you would like to change your PCP, please contact your Health Plans for details.

What do I do in case of a medical emergency?

In case of a life threatening emergency, please dial 911. For non-life-threatening emergencies, please call one of our contracted After Hours Urgent Care Centers.

Why is it important that I select an IPA?

You and your family’s healthcare is important from the first doctor visit onward, and you want to select a high-quality IPA that will best fit your needs and expectations. When you sign up for healthcare and don’t select an IPA, your insurance carrier will randomly assign you to one. PCAC IPA prides itself on its unique personal touch. Our physicians have trained at prestigious medical centers.

 How many physicians can I choose from?

We have over 2,000 physicians of all specialties.

What about quality improvement?

PCAC IPA leadership continuously monitors the healthcare providers’ quality of care. We set ambitious goals every quarter, with the goal of constant improvement in the care we provide our members.

Do I need to inform my physician if I change insurance?

Yes. Always inform your physician’s office when you change insurance. Your insurance coverage may vary with a new policy and your physician needs to know this.

Do I need to inform my physician when I change medical groups?

Yes. Your physician may have contracts with several provider groups. Each provider group has different policies regarding referrals and has a different panel of specialists. To make sure that you are referred to the right specialists, let your physician know if you change medical groups.

Should I always show my insurance card when I visit my physician?

Yes. It is best to always present your most current insurance information at each visit.

What if I lose my insurance card?

If you lose your insurance card, call your health plan member services department and they will send you a new card.

Will my newborn baby be covered under my insurance?

Yes. Your newborn baby will be covered under your insurance for the first 30 days following birth. During that time, you must enroll your newborn as an individual so there will be no lapse in coverage.

What if I have more than one insurance policy?

Let your physician know. There are different policies regarding different insurance that you and your physician need to follow. You will not be able to coordinate benefits between your insurance policies unless your physician knows you have this option.

Can family members each select their own primary care physician?

Yes. Each family member can select a different primary care physician. For example, a woman may select a family practitioner, her husband an internist, and their children a pediatrician.

Can I change my primary care physician?

Yes. You may change your primary care physician by contacting your health plan. Call the health plan member services telephone number on your insurance card. If you do plan to change your Primary Care Physician, please be sure they are a PCAC Physician.

How do I get a referral to a specialist?

Our referral process is unique, fast and easy. If the specialty you need is on the self-referral list (Self-Referral Roster), you can make the appointment yourself. If the specialty is not on the self-referral list, your primary care physician (PCP) will help you obtain one.

Where do I go in an emergency?

If you have a true life-threatening medical emergency, you should call 911 or go to the nearest hospital or emergency room immediately. If the situation is serious but not life-threatening, the emergency room centers can be found here.How to assess if it’s a true emergency? Ask these questions:

Are you having difficulty breathing, pain to the point of crying or a sudden inability to move or talk? If so, call 911 or go to the Emergency Room.

  • Is your life or body/organ function in danger? If yes, go to the Emergency Room right away or call 911. If not, going to the ER might not be the best decision. You will get excellent care in an Urgent Care or your doctor’s office, you will not wait as long, and your copay will be lower. Studies have shown that care for non-emergency conditions is superior at your doctor’s office than at an Urgent Care or Emergency Room.
  • Is your symptom related to an illness you have? If so, seeing your doctor might be the best choice: since she knows you best, she will be able to give you the best treatment.
  • Is it one of these conditions: twisted ankle, a superficial cut to the arm, pain on urination or moderate belly pain? If so, Urgent Care might be the most convenient and cost-effective way for you to get great treatment.

What if I have a minor health problem after regular business hours?

Always call your primary care physician (PCP) first. There will be a message giving you an after-hours number and/or instructions to follow.

How do I know whether to go to the Emergency Room, Urgent Care or my doctor’s office?

Always try to call your doctor first. If it after hours, you can call your health plan clinical help line:

Blue Shield: 24/7 Nurse Help Line (877) 304-0504.

Brand New Day: (866) 255-4795

TTY: (866) 321-5955

24 Hour Nurse Line: (800) 377-7012

Humana: (800) 457-4708

Scan: 1-800-559-3500 (TTY Users: 711), 7:00 a.m.– 8:00 p.m., 7 Days a Week.

8 a.m.-8 p.m. local time
7 days a week.
Se habla Español.

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Our members should expect a prompt and courteous appointment process, a respectful, informative physician who is up to date and communicates openly with their patients and caregivers, as well as receive timely test results and patient callbacks. PCAC IPA’s doctors are measured on all of these criteria: patient access to the doctor, patient satisfaction and physician clinical skill. It is our goal is to help our physicians practice excellent medicin

It’s A Wrap!

And that is for “What is an IPA insurance?” The IPA insurance system has achieved excellent results and is preferred by many insurance companies. IPA is expanding efficiently as this system let physician work independently without worrying about the cost.

IPA insurance system is successful and will be more popular if it shows an increase in the number of treated patients compared to the famous health care organization and well-capitalized clinics. This article, “How does health insurance work?” might help if you find this hard to understand. Thanks for reading!

Helen Skeates

Helen Skeates

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