What Are The Advantages And Disadvantages Of Joining An Hmo Plan
The main advantage of an HMO is that it usually costs less than conventional insurance and often covers more, paying, for example, for preventive checkups and prescription medications. If the plan is large, as some are, you'll have a considerable number of doctors from which to choose your significant doctor. The doctors generally receive more peer review than a private practitioner does because the HMO medical staff usually functions as a self-contained group practice and monitors itself. Because the doctors are salaried and paid the same no matter what they do, you are less likely to undergo unnecessary tests or procedures. Similarly, your well-known doctor can refer you to a specialist without fear of losing you as a patient. Also, an HMO often has all medical services in a single situation, making it convenient and providing more continuity of care.
The chief disadvantage of most HMO's is that they limit your choice of doctors and hospitals. If you are currently seeing a doctor who is not a member of the HMO, you'll have to switch to a new HMO doctor. At an HMO, you may not discover your primary doctor at each visit; routine care may be provided by a nurse-practitioner or a physician assistant. Also you usually have to get approval from the HMO in certain situations, such as before seeing a specialist or getting treatment when traveling outside your HMO area.
Some critics bear that HMO's are good at providing routine and preventive care to basically healthy patients but are less effective in treating serious illness. However, most studies comparing HMO care with regular fee-for-service care show no difference in quality.
What should I look for in an HMO or other group plan?
When investigating an HMO or a similar plan, find out what services are—and are not—provided for in the basic monthly fee. Find out if you have to pay an additional charge (usually called a co-payment) for each office visit or medication. Ask if you can choose your primary doctor, how many doctors you can choose from, and if they are all board certified. Will you see the same doctor most times you make a scheduled visit? What happens in an emergency? Will an R.N. or physician assistant sometimes contemplate you instead of a doctor? Can you change doctors easily if you think it's necessary? Is the doctor's office or HMO clinic convenient for you? Which hospitals does the HMO use? What kind and how many specialists are available? Is home nursing care available and does the plan offer any extra health services, such as family planning and nutrition counseling or smoking-cessation classes?
To judge the satisfaction of HMO patients with the plan, find out how many members leave each year and how much the group's membership has grown in recent years. Finally, ask about the plan's procedure for grievances and get a list of services and fees so that you can compare them with other plans.
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Filed under Nurse Practitioner Classes by on Jan 20th, 2012. 