Health Maintenance Organizations:MyQuickInsurance.Com, Inc.

  Here are some information that could be useful for health insurance shopping

Health Maintenance Organizations

Health Maintenance Organizations

Health Maintenance Organizations are a typical type of Managed Care Organizations (MCO). It is both insurers & health care providers. Anyone who joins HMO is considered as members. Under this plan, Health care providers make a contract with HMO to part their services at a discount. This contract facilitates HMO to charge lower monthly premium, which comes as an advantage to its members. Members of HMO have to pay monthly premium regardless of their medical needs, while in return HMO provides them with various medical services.

To achieve the above advantage HMO requires members to select a Primary care Physician (PCP) a doctor who acts as a gateway to medical services. HMO members have to first go through the PCP, who authorizes referrals to specialists or other doctors if necessary, however emergence medical care is exempted from PCP.

If any HMO member visit any medical practitioner with no referral from the PCP then that visit or treatment will not be paid for by the policy. This is a primary criticism of HMO as it limits their members on their own health care needs.

HMO members face a number of restrictions:

Members must live in the HMO service area.

Members must use a primary care physician who belongs to the HMO, and often will not be granted access to a specialist without this physician's recommendation.

Members may not be able to get their HMO's to provide them elective medical services, or may face delays for those services greater than under a traditional fee-for-service plan.

These are a number of possible benefits:

Preventative Care Insurance companies generally pay for medical services only upon illness or injury. HMO's are supposed to provide medical services that prevent illness or injury, making medical care both higher in quality and cheaper in the long run. One example is physicals: HMO's often require that members undergo physicals; traditional Medicare fee-for-service usually refuses to pay for physicals.

Broader health coverage HMO's sometimes offer more services and broader coverage than Medicare policies, even when those policies are supplemented with Medigap insurance. For instance, many HMO's provide dental and routine eye care.

HMO's require less paperwork than Medicare insurance.

self employed health insurance quote Click for a FREE Insurance Quote