Health Maintenance Organization
Only twenty-five years ago, most Americans depended on standard
indemnity insurance plans to service their healthcare needs. With
standard indemnity coverage, plan participants would visit any
specialized care provider, doctor or hospital they chose then submit
a bill and be reimbursed by their insurer for whatever portion
of their medical expenses their individual health plan allowed
for. But, things have changed . . . our nation's healthcare system
has and continues to undergo a slate of fairly dramatic upheavals.
Though many of us are still carry private health insurance, more
than half of all of the Americans with health insurance are enrolled
in one brand of managed care plan or another.
The various sorts of managed care programs range from Point
of Service Plans (POS) to Preferred Provider Organizations (PPO's)
to the increasingly popular Health Maintenance Organization or
HMO. No doubt, most health services consumers will have heard
at least one or two of those terms before. But, what are the
essential differences between the ways in which they function-and
more importantly, exactly what will those differences mean to
the average consumer?
HMO's or Health Maintenance Organization's are health
care programs created with lowering health care costs both for
you and for whichever carrier or group provider is responsible
for paying for your healthcare. By joining an HMO, consumers
are getting access to the use of their assorted services at a substantially
reduced cost, at rates that are more often than not far less than
those associated with doctor or hospital care. Health Maintenance
Organizations are typically enormous networks capable of purchasing
medical services for thousands of consumers while deciding what
types of health care they'll be receiving. Sheer volume gives HMOs
the means to lower overall health costs as well give companies
cheaper health care rates for their employees.
Though HMO's all have their unique values, deficits and differences,
they all also have a number of common features. Every HMO Plan
requires that its participants employ hospitals, doctors and care
providers from within the plan's network. In addition, HMO Plan's
generally require that their members choose primary care physicians
who will thereafter be responsible almost solely responsible for
administering their healthcare. Plan members in need of specialized
care are even obliged to first get approval from their primary
care provider - a process that isn't quite as difficult or cumbersome
as it might sound.
Obviously, the foremost advantage of an HMO membership is
lowered costs. They're able to provide consumers with this plus
in a variety of ways. First off, managed care premiums are almost
always lower than those of traditional health care plans. Secondly,
managed care programs do not generally oblige consumers to pay
for their medical care upfront, which tends to leave out long periods
of waiting for repayment as well as reams of claim forms. And finally,
Health Maintenance Organizations generally require only a relatively
miniscule co-payment for prescriptions, hospital stays or physician
visits. But, none of that means that there aren't disadvantages
inherent in HMO Plans as well - and consumers must always take
care to familiarize themselves with the ins and outs of particular
plans using a reliable comparison shopping and informational resource.
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