HMO Insurance - Health Insurance Quotes

HMO Insurance

The letters HMO refer to health maintenance organization. This is one of the most popular types of health insurance plans in America. It?s typically a prepaid insurance policy in which members pay a monthly premium for their coverage. Comprehensive health care is provided by a contracted network of health care providers, such as doctors, clinics, hospitals and other medical facilities. If an emergency arises though, you?re allowed to get treatment from a provider outside of the network.

Each time you visit the doctor you usually have to pay a co-payment and you?ll also be asked to select a primary care physician, also known as a PCP. This doctor is the first person you?re asked to visit when you feel you need medical attention. You?ll also see this physician for preventative care and routine checkups etc. If you don?t choose a PCP the insurance provide will assign one to you. After diagnosis, if the PCP feels you need to see a specialist or another doctor, he or she will refer you to one.

However, if you visit a specialist without a referral, most HMO plans won?t cover it, even if the specialist belongs to the network of providers. Exceptions are often made for emergencies though. There are several few types of hmo health insurance?plans available. For example, a group plan will offer health care providers that are located in a specific geographical area. Patients who live here are asked to see these medical professionals when they need attention.

The doctors and other providers who belong to the network are paid a monthly fee for every HMO patient that they treat. However, they?re also allowed to treat people who aren?t members of the HMO. A captive group HMO is different though since it?s restricted to members of an hmo insurance plan. Another type of HMO is known as the staff model. In this plan, the administrator of the HMO owns and manages the medical center where its members are treated.

An?hmo medical insurance?differs from a PPO (preferred provider organization) is several ways. However they?re also similar in some ways. With a HMO you need to visit health care providers which belong to the plan?s network. In a PPO, you have the choice of getting medical care from providers that belong to the network or those who don?t belong to it. But be aware if you visit an out-of-network provider it will generally cost you more.

You don?t need to choose a PCP in a PPO, but you do with a HMO. Also, in a PPO you?re allowed to visit a specialist without a referral. The health care providers in a HMO have to file claims to get paid, but the members don?t have to file them. In a PPO, you could have to file a claim if you visit a provider that doesn?t belong to the network and you may have to pay any part of a doctor?s fee which the PPO doesn?t cover.

You may visit an out-of-network care provider when you belong to a HMO if the plan?s network doesn?t offer that specific type of medical care health care. In a PPO, you generally pay up front when visiting non-network providers and get reimbursed.

HMO insurance is straightforward to some people, but it can be a little confusing to others. It?s always a good idea to have a licensed insurance agent or broker fully explain how each plan works and what it offers.

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Source: http://www.1-health-insurance-quotes.com/hmo-insurance/

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