Relationship between HMOs and Health Insurance

HMO means – Health maintenance organization. Through a network of providers that come into terms to supply members with health cover, HMO plan provides a wide range of health care services. The HMO health insurance plan covers a wider range of preventive health care services than any other type of plan can give. The key role for the Health Maintenance Organization is to take preventive measures and be ready to spend in order to keep their members healthy and take proactive measures against higher health care costs in the future.

How do Health Maintenance Organizations work?

HMO is focused on providing insurance to large numbers of people in a country. Thus, they operate on a very large-scale that involve: primary care physicians, specialists, hospitals and clinics among other facilities where their members receive health care services. Members of a HMO are required to select their Primary care Physician (PCP).The Primary care physician takes care most of your health care requirements. A PCP provides you with a referral if you want to see a specialist. Furthermore, members or patients that belong to a specific HMO are required to get health care services at certain facilities or specified providers within a certain network. This is because there are providers who have signed a contract and agreed to adhere to the HMO’s guidelines and restrictions. HMOs also function by receiving a fixed payment that is submitted on specified period like say on a monthly basis by its patient for the services they are offered.

HMO has several benefits

For the commercial HMOs with both privately insured patients and Medicaid, they are in a position to reduce health care expenses as a result of a large number of people being covered by the Health Maintenance Organization. Health Maintenance organization expenses are reduced because patients have to receive referrals from Primary care physicians who only approve necessary medical services. Most of the HMOs don’t need deductibles which saves patients a lot of cash. For every person they cover, HMO receives a flat fee and patients can be assured that their monthly payments remain the same despite their utilization of the health care system. Another advantage is that you don’t have to submit your claims to the insurance company.

HMO has some setbacks

HMO might have some un-ethical health providers that don’t perform tests as required, or prescribe drugs or treatments to increase their points. Also, patients are used to selecting medical providers of their choice, but with HMOs, one has to stick to the health providers within their network. In addition, if there is a specific provider you need but they are not in the HMO, you will need to pay all costs in order to obtain their services. Sometimes, the HMOs don’t prescribe experimental drugs due to the high costs of such products.

Before listing down your HMOS, consider checking out and comparing them as they have different quality ratings and ensure that you’re okay with your primary care physician. With HMOs, people receive affordable and quality health care services.