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What is HMO?
You arere looking for the right health insurance and you have got your budget in mind. Turns out one of the most common managed care plans is usually the most affordable: Health Maintenance Organizations, or HMOs.
HMOs were created to lower your healthcare costs. Their large risk pools and pre-negotiated fees make it possible to offer you substantial savings. By joining an HMO, youýll get to use the services of their doctors, specialists, hospitals and clinics at a relatively low cost.
What HMO Plans Have in Common
- All HMOs require you to use doctors and hospitals that are members of their "networks."
- An HMO requires you to select a primary care physician who is in charge of your care and can refer you to specialists or a hospital, etc.
- HMOs don't require you to pay for your health care up-front, so there won't be any claim forms to fill out or long waiting periods for reimbursement. Finally, the majority of HMO plans require relatively small co-payments for office visits, hospital stays, or prescriptions.
Things to Consider
HMOs have their downsides as well. You will be required to use only the doctors and hospitals, clinics, etc. that are members of your HMO network. An HMO receives a flat monthly fee for everyone they cover -- and that practice tends to lead to more restrictive care practices (difficulty accessing medical specialists, getting expensive drugs, etc.).
Also, it can take time to get the required approval from a primary care physician, something anyone with a serious illness, such as diabetes or cancer should be well aware of.
Selecting your primary care physician will be your most important HMO decision. Your primary doctor may need to act as an advocate if you're in need of specialized care or medication treatment. You will always have the option of changing doctors, but establishing a good relationship early is important in an HMO plan.
Making the Decision
Before you decide to join a managed care network, you will be given detailed information on the plan. We'll lay out exactly whats covered, what isn't, how you'll need to go about appealing any decisions that don't go your way and more. You'll also have an assortment of legal rights to help protect you., And don't forget, we're here to answer any HMO questions you may have.
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