HMO – how does it work ?

One of most popular managed care health insurances that you can get is the Health Maintenance Organization a.k.a HMO. As a part of HMO plans, the doctors, health care facilities contract with the insurance company in order to provide the medical treatment to their customers at a discounted price.HMO members must follow guidelines and orders set by Health Maintenance Organization so that they can claim their health benefits easily.

How Health Maintenance Organization or HMO works?

HMO plans requires the members to pay a monthly premium. HMO plans generally does not require you to have a coinsurance with the HMO plans.The HMO network size varies from area to area and it’s very important to check the list of providers while selecting the HMO plan. While HMO plans are generally considered to be the most affordable plans, they are also considered as the restrictive form of health care insurances.

If you are a HMO member, you need to select a primary care doctor or physician upfront. You are free to choose your own physician as long as your physician is in a network connected with Health Maintenance Organization. If you do not want choose your primary care physician, HMO will assign a primary care physician to you. A primary care physician is usually a family practitioner who will be your basic care doctor. If you are not comfortable with your primary care physician you can change him or her anytime.

Your primary care physician will be the one who will decide types of care that you need to get. He or she will decide if and when you need to visit a specialist and get a certain medical service. You need to get the referral of your primary care physician in order to visit a specialist doctor.

You must get medical services and equipment only from HMO-in network providers. Health Maintenance Organization will help you obtain list of health care services providers and medical equipment providers who are under their network. HMO-in network providers cover different health care service that you need such as medical services of pharmacies, specialists, doctors, therapists, x-ray facilities and many more. Make sure that you will get health care services and equipment only from HMO-in network providers because if you get services from out-of-network, HMO will not pay it and you are required to pay it without asking financial assistance from HMO.

Exceptions about Getting your Primary Care Physician
You are allowed to get out-of network service provider during emergency situations that assigned in-network primary care physician cannot attend to you.
There is no HMO-in network provider who specializes to your medical needs.
You can continue your medical treatment under an out- network provider if you are in the middle of treatment when you become a member of Health Maintenance Organization and if you cannot cancel your treatment with your physician.

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Posted in Health Insurance

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