|
|
| CLINICAL
MIND > INSURANCE |
|
|
| |
|
|
|
| |
Health
Maintenance Organization (HMO) |
| |
|
| |
As the name actually implies, an HMO places emphasis
on maintaining optimal health through regular
visits to your doctor. The idea is that most major
illnesses can be prevented through inexpensive
testing and regular visits to physicians. Here
are four basic facts about HMO’s that will
help you better understand how they work: |
| |
| |
|
| |
All
physicians and specialists are part of
a network.
Participants must choose their doctors
from a list and only see physicians included
in the plan. It is typically not possible
to see any doctor’s outside of the
list on an HMO. |
| |
|
| |
Less
expensive than PPO.
Premiums are lower on HMO plans and so
also are the co-payments which may even
be waived on some plans. |
| |
|
| |
More
Restrictive than PPO.
While less expensive, HMO’s typically
have a “Gatekeeper” otherwise
known as your primary care provider. This
doctor will have to be seen before you
can gain access to specialists on the
network. |
| |
|
| |
Networks
tend to be overcrowded.
Because emphasis is placed upon regular
visits to the doctor, the HMO networks
tend to get crowded making it difficult
to get into to see your primary physician.
In really severe cases of overcrowding,
it can sometimes take a month or more
to see your doctor for a regularly scheduled
visit. |
|
| |
|
| |
The "Gatekeeper" function of the primary
physician in HMO plans really tends to limit health
care options especially when a patient disagrees
with the doctor’s diagnosis or treatment.
You are not locked into keeping any one primary
physician but it will often take weeks before
the necessary paperwork can be processed and your
choice changed. Then, if the other doctor still
agrees with the original assessment, the patient
will again need to switch physicians if they think
they need to see a specialist but the doctors
disagree. In theory, by having those in an HMO
plan see their primary physician first, the propensity
to drain the insurance fund with unnecessary specialist
visits is minimized. This may very well help keep
the costs down for those enrolled in an HMO plan
but it can be very restrictive for participants
and is often a source of contention for those
enrolled when they disagree with the "Gatekeeper's"
assessment. |
| |
|
| |
| |
|
|
|
|
|
|
|
|
| |
|
|
| |
|
|
| |
|
|
|
