Choose your health insurance wisely.
For almost 50 years, health maintenance organizations (HMOs) have been billed as the cheapest way to deliver medical care to our growing population. With an HMO, people see doctors who have contracted with the HMO. The major benefit of an HMO is that the insureds usually pay significantly less for their medical care. But HMOs do have several drawbacks.
Seeing a Specialist
In an HMO, you have a primary care physician (PCP) who handles most of your medical care. However, if you need to see a specialist, you need a referral from your PCP and usually the approval of the HMO. There is no guarantee that the HMO will approve the referral, and it can be a lengthy process even if you are approved. Usually, if you want to see a specialist outside the HMO network, you have to pay substantially more.
Changing Your PCP
If you have a problem with your PCP, it can be difficult to make a change in an HMO. Many HMOs limit how often you can move to a new PCP.
Portability
If you get sick while out of town and there are no doctors or hospitals there that are part of the HMO's network, you might not be covered by your HMO. Make sure you understand how your coverage works when you are away from home, especially if you travel regularly.
Quotas
Doctors who enroll in an HMO are assigned a number of patients and might be required to see a certain number each day. This could mean your doctor is seeing more patients than she would like to see, which could lead to her having less time for you.
Preapproval of Tests
If either your PCP or a specialist recommends testing, you probably will need approval from your HMO, just as you would from many other plans. This process can lead to delays in the treatment of your illness.
Approval process
When you request approval from your HMO for a procedure, that approval probably will be guided only by the terms of your HMO contract, which can be very narrow. For example, if your doctor suggests that you go to the hospital's emergency room, you might be turned down for coverage because of your HMO's strict interpretation of the term "emergency."
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