A Health Maintenance Organization or HMO is an organization that provides medical insurance and health care services for its members. Most all HMO’s provide insurance coverage for primary care physician, emergency care, and specialists and hospitalization. Preventive medicine is the key to insurance HMO philosophies in order to provide health care to prevent disease or illness.
The most common line of thinking in regards to HMO insurance is that you are not given a wide choice of primary care physicians and that routine care can feel a little impersonal. Critics of HMO’s also claim that denial of adequate referrals in the event of disease, illness or injury are standard practice in order to have a better level of insurance profitability as opposed to providing the best level of care for patients.
There are many fine HMO’s that provide excellent care for their patients and pride themselves on exemplary standards of service while still managing insurance costs. An IPO (Independent Provider Organization) operates by having an HMO work with and contract directly with independent physicians to provide insured services to its members. This insures that a doctor will not have an interest in the HMO directly and thereby can give the level of care he would normally give under any insurance, without compulsion to save costs at the expense of proper care.
Because of concerns about the level of care being offered many HMO’s subscribe to PRO (Peer Review Organization) insurance review services that assure that members are receiving appropriate services and care. They usually handle insurance complaint resolutions as well. It is important to review your insurance choices carefully to find an HMO that will provide you with the level of care you expect.
The benefits of HMO coverage and insurance include:
- Lower out-of-pocket expenses
- No deductibles or plan limits
- No paperwork or claim forms
- Low co-pays for doctor visits
- Very low or no deductible for hospital visits
- Pre-existing conditions may be covered
- More comprehensive coverage
- Covered for emergencies while out of state.
Your HMO might limit you in your doctor choices and HMO facilities but when you factor in the savings and the nature of putting preventive health care in the forefront you can see the advantages of an HMO plan. HMO plans in relation to dental coverage can sometimes be limiting. The dentist might not accept an HMO plan as an independent provider. The basic preventive care can be very good under an HMO plan but it might have too many limitations for extensive dental work.