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Health Maintenance Organization

Health Maintenance Organization

A Health Maintenance Organization (HMO) charges a monthly payment and the insurance company along with its network provides arrays of advantages, in return. Since, the advantages provided may vary from plan to plan, it's always better to opt for a comparison shopping.

With a Health Maintenance Organization (HMO), you're agreeing to take advantage of one particular insurance company's network; however some exceptions are sometimes entertained in case of an emergency. It indicates that you will choose your primary healthcare doctor from the list of approved doctors provided by the insurance company. Your chosen doctor will be accountable for your general healthcare, recommendations, prescriptions as well as approval of any extra medical treatment.

A Health Maintenance Organization (HMO) requires you to make co-payment for the doctor visits and prescriptions; on an average, a normal visit to your doctor requires you to pay from $5 to $20. In case of visit to a doctor outside your insurance provider's network requires you to pay the full charge.

Advantages of a Health Maintenance Organization

  • Reduced quantity of paperwork - An HMO member is normally provided with a card that he or she can produce at his doctor's office or the pharmacy, instead of filling out several forms.
  • Focus on the preventive care - Since it's in the HMO's better interest to take care of you before you get seriously sick, Heath Maintenance Organizations encourage their members to ask for treatment earlier and most of the time offer advantages like health edification class or cut-rate health club membership.
  • Low out-of-pocket expenses - The co-payments you have to bear with the HMO plan are mostly less than the deductible you may have to pay with other forms of health insurance plans.

Disadvantages of a Health Maintenance Organization

  • Limitations to the HMO's network - If you currently see a doctor, who is not a part of your HMO's network, you'll have to find a new doctor who is a part of the network; otherwise, you have to pay the full price for doctor visits. Moreover, hospitals and doctors can opt for leaving a network at any point of time; absconding you back at the square one.
  • Difficulties in getting expert treatment - Your primary-care doctor should be consulted prior to getting care from other doctor or specialist. The doctor should provide you with recommendation, if you need a specialized treatment with no network referral. However, you have to bear the cost.
  • HMO plans can be a great option for people - Wander around and find out one that has both facilities and providers conveniently situated to your locality. Individuals who often make non-emergency doctor visit, like children and women, are good consumers for the HMOs. However, HMOs are not a good choice for the people who frequently travel or are attached to any particular doctor not approved by their HMO's network.

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