Understanding HMOsOf all the group health insurance plans out there, the HMO is the most common and cost effective. Gaining an understanding of HMOs is simple if you read on. Understanding HMOs Health Insurance has been going through a crisis for the last three decades. The cost of medical care kept rising and the group health insurance plans were being forced to constantly raise premiums while at the same time increasing deductibles and exclusions. In recent years, a new type of health insurance provider has emerged on the stage. They are the Health Maintenance Organizations, or HMOs. The HMO was created and experienced rapid growth and popularity because they were designed to manage health insurance from both the perspective of the provider and the insured. Get California Health Insurance Plan Quotes This idea of management of health insurance gave these plans the common name of managed care providers. The HMOs work by creating a network of health care providers. These include doctors, specialist, hospitals, and clinics. This network is basically under contract to provide certain medical treatments to members at a set cost. The providers benefit by having more patients and the patients benefit by having lower and more standard costs. When the costs are standard and lower, the HMOs can provide health insurance for a lower premium with less deductibles. Understanding HMOs involves understanding that the managed care principle really does apply both ways. The patient is managed also. Each insured member is assigned what has been called a “gatekeeper” physician. This is usually an internist or family doctor and his role is to coordinate all of your medical care. Regardless of your condition, this gatekeeper doctor must see you first and approve any subsequent treatment. Emergency care is usually an exception, but the amount of co-payment required when going out of the network usually keeps members going through the proper channels. Get California Health Insurance Plan Quotes HMOs have come under criticism lately as they continue to attempt to decrease medical costs by eliminating certain unnecessary procedures. They work with physicians to devise methods to encourage them to withhold certain treatments that might not be absolutely vital to the recovery of the patient. Some patients have complained about this reduction in treatment. The HMOs were the leaders in encouraging preventive care. They have realized that the least expensive way of treating any illness is to prevent it in the first place. In most cases, preventive care is covered under the basic plan with only a small, or no, co-payment. On the other hand, elective treatments such as cosmetic surgery will almost never be covered. A form of HMO that allows a bit of choice in treatment and physician and does away with the “gatekeeper” is the PPO. The Preferred Provider Organization is a type of HMO that allows some deviation from the network although at a higher cost. << Back to Health Insurance Information
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