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Health Insurance
Health Maintenance Organization
Health Maintenance Organizations come under the category of Managed Care Plans. In a HMO Plan you will be paying for coverage in advance and in most HMO Plans as a member you will also be making a co-payment for a doctor’s visit, hospital stay or visit to a specialist health center.
In an HMO Plan, you will have to select a Primary Care Physician who is in the HMO network of doctors and physicians. The Primary Care Physician (PCP) will be your first point of contact, and setting a good relationship here is important. Your PCP will take care of arranging, coordinating and authorizing every aspect related to your health care and is also referred to as the gatekeeper. If you need any specialist treatment your PCP physician will refer you to the specialist who will also be within this network. You can change to another physician in the network if required.
The PCPs in a HMO network are usually general practitioners or doctors specializing in internal medicine, obstetricians or gynecologists. If you would like to take the services of a specialist, like a cardiologist or a rheumatologist, your PCP should authorize it so that it is covered under the HMO plan. If you go to a specialist without such authorization you have to pay up entirely for the service rendered as this will not be covered under your HMO plan.
HMO’s can be in the form of group HMO’s where patient’s have to go a single area in which all medical assistance is provided such as a group of clinics or a hospital. It can also be in an individualized form wherein there is a contract between the HMO and the doctors in private practice.
In a HMO Plan you need not fill out any claims forms or wait for a long period of time till you get reimbursed. Another benefit for a participant in this plan is the low co-payment. HMO’s are most suitable for those who are young and do not have a family to support. HMOs mainly stress on following preventative care to avoid major illnesses which means excess spending on medical costs can be avoided.
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