HMO insurance comes in several different models.
An HMO, or health maintenance organization, is a type of health insurance that consists of a group of health care providers who offer their services to individuals and families who choose to participate in their group. All HMOs are not the same. Several types of HMOs exist, each with its own structure and regulations.
Staff Model
Health care providers in this model are direct employees of the HMO. They have offices in the HMO's buildings and receive a salary directly from the HMO and see only patients belonging to the HMO.
Group Model
In this model, it's the group rather than the individual providers that contracts with the HMO. The HMO pays the group, which in turn decides distribute the money among each of its members. Providers within a group model do not see patients outside the HMO.
Open-panel Model
Health care providers who wish to see both HMO and non-HMO patients and use their own offices can contract with an IPA, or independent practice association, which in turn contracts with the HMO. The IPA receives a fixed amount for each of its patients. Because of their ability to see non-HMO patients, you can continue to see providers in an IPA even if you started seeing them through an HMO and are no longer a member of the HMO.
Network Model
The commonly-used network model involves an HMO contracting with a combination of individual providers, groups and IPAs, often creating a wider range of providers for its members than the other models.
Tags: care providers, contracts with, individual providers, Model Health, Model Health care, non-HMO patients
