YOUR
BOTTOM
LINE ON YOUR
HEALTH INSURANCE

An HMO is a collection of health professionals, doctors, physicians, hospitals, psychologists, mental health care workers and other specialists, who work for a set fee.

With a broader spectrum of doctors and other health care workers they can agree to a set fee for service with many different HMO plan companies and are not actually owned by the HMO itself.

There are smaller, independent HMOs where all the staff members that work there work directly for that private HMO.

However, HMOs do have their downside.

HMOs ARE in business to make money and so if you have many health care issues, you may not be accepted to begin with, or they could insist that you have to pay more.

Verily, verily I say unto you, if you have a chronic medical condition that requires many visits, tests, and treatment you will cost the HMO lots of money and they WILL resent it. They contain the cost of treating you by keeping a tight hold on your health care expenses. They will insist on approving all your visits prior to you going.

In short, you will find that most HMOs are usually extremely restrictive -- and have lots of rules that must be followed if you want them to pay. You can only see the doctors on your HMO list, and you must see your primary care doctor first, no matter what is wrong with you.

When and if you need to see specialist, you must have seen your doctor first to make sure they can’t treat you instead of wandering off on your own to a more expensive doctor. Even if you feel an urgent need to go to the hospital you must have your primary doctor’s permission prior to going or you could very well end up paying the bill. The HMO makes sure it is their doctor who has control over all your medical needs, not you. HMOs can also be a bit fussy when you want to change your primary doctor.

So be sure that you like your doctor and you really should speak to other people who are patients in this system.

Whole bunches of people find these restrictions altogether too irritating and choose not to go with HMOs for that very reason.

Now, on the other hand, most doctors working in the HMO system are excellent. They will hand out referrals cheerfully if they even suspect they are needed.

Another thing, most doctors these days are enrolled in these same HMO plans themselves so they WANT them to work well for the patient.

Most HMOs also have a patient quota that the doctor has to comply with. He or she must see a set number of patients per day to avoid penalization or being removed from the group. This is why there is never enough time to talk with your doctor past your examination point. They need to keep it short so they can see more patients.

There is also the concept of Capitation that gives contracted doctors a set amount of money for each patient each month. This is given no matter if the patient is sick or well. But for most people who have HMOs this is not a problem and their doctors are great.

Another thing to consider is continuity. Are you SURE your life is settled now, or might you be moving to another area soon? Will THIS HMO move with you? If you develop long term problems and still have to move – leaving your beloved HMO behind, you may very well have to get under someone else's protection umbrella – at a far higher premium cost.

Lastly you must make sure any labs or tests you need are covered with your plan or they just flat out won’t be covered.

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