What is an HMO Health Insurance plan?

HMO stands for Health Maintenance Organizations

With HMO plans, you will need to select a physician in your health insurance carriers network of doctors.  This doctor is your primary care physician (PCP) and manages all of your care. If you need services out side your PCP scope and need to seek services from a specialist they should refer you within this list of doctors for your health insurance plan.

Most HMO plans have only copays for all services including hospital, out-patient surgery etc.  However, there are some HMO’s health insurance plans that have a deductible and coinsurance component attached to the insurance plan.

It’s important to note, when you are enrolled in an HMO type of health insurance plan, you must use the list of doctors for that insurance carrier.  If you decide to go out side this list you may be responsible for all claims incurred.  The one possible exception is in case of a true emergency i.e. having a heart attack, car accident, etc.

As with most plans HMO’s still have their place in the insurance market.  More times than not the HMO plans tend to be higher in cost than a PPO plan. But of course, this all depends on the health insurance carrier, health plan, etc.

With any health insurance plan type you are enrolled in or thinking of applying for, please always make sure when you schedule an appointment with the doctor’s office that they are in fact a contracted doctor for that health insurance plan.  There are several ways you can check to make sure of this, call the doctor’s office and confirm they are still contracted and the best option would be calling the insurance carrier to confirm that doctor is contracted.  This way the insurance carrier can document you called to verify should anything happen with the claim after the fact.

Even after you have seen that doctor it is possible for whatever reason that doctor is no longer contracted ie they were dropped by the insurance carrier or decided to cancel their contract with the carrier.

So make sure whenever you go they are still contracted.  I know it may seem like a pain now but a few seconds on the phone confirming is better than getting a nice big bill in the mail ;)

As mentioned in previous posts, please refer to your specific health insurance summary plan description for complete benefit details.

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