HMO Health Insurance

HMO Health Insurance, or Health Maintenance Organization, has garnered a bad reputation that it doesn’t completely deserve. Some people claim that HMO health insurance, compared to Blue Cross Health Insurance, limits their healthcare options, but, really, like all healthcare plans and mostly anything else, whether HMO health insurance works for them or not all depends on what their needs are.

Here are the basics about HMO Health Insurance so you can make up your own mind.

HMO Health Insurance is a form of managed care insurance. An organization providing this health insurance works with doctors and hospitals to form a network. These doctors are contracted with HMO for lower prices and might have to subject themselves for utilization review. The HMO reviews the dollar amount or number of visits a person uses in a month and scrutinizes for excessive medical care.

When taking an HMO Health Insurance policy, a person chooses a primary care physician from within the HMO’s network. That physician then becomes your main source for healthcare and would give you a referral before you’re able to seek other medical help such as from a specialist. Women choose an OBGYN after signing up who are also be able to give referrals. Also, parents choose a pediatrician for their children.

Set up like this, the HMO Health Insurance company lowers the overall cost of health insurance and increase the amount of benefits. They do this by having their contracted healthcare providers offer lower prices for network inclusion. Plus, due to the utilization review the HMO Health Insurance Company puts its doctors through, they save money by making certain patients don’t receive unnecessary treatments. This lowers the overall cost of the insurance itself and allows them to increase the amount of benefits.

The utilization review can be limiting. If a doctor wants his or her patient to receive a CAT scan or some other medical procedure, someone working for the HMO Health Insurance Company may review the case and disagree. The doctor then has to work this out with the HMO Health Insurance Company worker before giving his patient care.

Also, a consumer can only see a doctor within the HMO Health Insurance Company’s network. If they are referred to a specialist, then that specialist must also be a part of the network. This one is of the main hang-ups with HMO Health Insurance. A lot of people find this too restricting and prefer the freedom of choosing any doctor they want.

The trade-off is that HMO Health Insurance is the least expensive health option along with being the least flexible. HMO’s tend to see the big picture, which is why they have utilization reviews and have their consumers only see healthcare specialists within the network. It cuts costs.

Doctor’s visits, preventive care, and medical treatment are given in exchange for a monthly premium and a co-pay of roughly $5-$10. HMO Health Insurance prescriptions work a little differently. An employer decides what percentage of prescriptions will be covered by an HMO and what percentage the employee will have to pay themselves. The coverage price may range anywhere from a co-pay of $5 for some drugs to a co-pay of almost the entire amount for others. It all depends upon the owner’s discretion.