What is an HMO?

The abbreviation HMO stands for health maintenance organization. It is a type of managed care organization that provides health care in America that is fulfilled through contracted hospitals, doctors and other providers. HMO caregivers have sets of care guidelines they are required to follow and that is prevalent throughout a network of providers. Since providers contract with an HMO to receive more patients they can generally charge lower monthly premiums. The tradeoff is limitations on the treatments available to patients.

When you join an HMO as a patient you are asked to choose a primary care physician. This doctor works as the HMO’s agent so to speak as they determine which treatments you do or don’t need. If for some reason your primary care provider feels that you need a treatment they can’t provide they will refer you to a specialist in the network. The only exceptions to this rule are emergency room visits and OB/GYN doctors.

The thinking behind an HMO is that your primary provider will know you well enough to effectively provide you with care that eliminates unnecessary services. This primary provider should know your personal, family, social and financial situation to help determine what is best for you. You can see this person for routine visits as well as unexpected illnesses and they can do tests, provide treatment or prescriptions as necessary.

Once you are passed on to a specialist they are still in your HMO network. The reasoning behind this is once again to control costs. An expanded network can include psychiatrists, dentists, physical therapists, hospitals, pharmacies, and nutritionists among other specialists.

One major concern people have with HMOs is that they might not allow a person to get the medical attention they need in order to save money. However, most people are quite happy with the concept of an HMO and the care they can get under the program.

If you are thinking of joining an HMO you should consider first and foremost your own health needs and make sure the organization can provide you with what you need now and in the future. Also consider if you’ll be able to use your current provider and/or specialists in you switch to the HMO network. If you can’t switch, decide if that’s okay and if you can find a suitable replacement.

Check into the HMOs reputation. Find out if they have a history of complaints or if they are known for giving quality care. Some of the better-known HMOs are Blue Cross and Blue Shield and Kaiser Permanent. Also see if the charges are reasonable compared to what type of coverage you have now. While an HMO is often less expensive, it isn’t always the case.