What is HMO health insurance?

HMO health insurance is a health coverage offered by health or HMO maintenance organizations. This type of health insurance is considered to be a subgroup of prepaid medical services in which the organization members can obtain medical services from a selected group of doctors and medical facilities. The structure of most HMO health insurance options differs from other health insurance options in that the cover is only valid when a member uses the services of doctors and facilities that have a contractual agreement with the organization.

While there is some difference in the operating structure, most HMO health insurance plans require each member to choose a primary care doctor. This doctor acts as a pipe through which all medical services provided within the plan must be arranged. For example, if a member feels the need to see a specialist of any kind, he must first receive recommendations from a physician's primary care before HMO compensates for a specialist for the services provided.In addition to the medical emergency, the member must always go through a primary care doctor before looking for any type of indoor medical treatment from another healthcare professional, although this professional is also part of the HMO network.

HMO care is to provide affordable and competent medical services as many people as possible. At the same time, the structure of health insurance is also designed to remove disturbing treatment, tests and other factors that often increase the cost of medical care up. These two primary objectives helped increase the attraction of health insurance in the United States during the 1970s of the 20th century, which forced a number of companies to move from traditional health insurance possibilities to the HMO plan.

HMO health insurance providers normally operate in one of the two models. With a group model of the organization, it concludes a contract with doctors in a given geographical area to pushedVala services to members staying in the region. Doctors are paid a monthly fee for each member of the HMO laid in their care, providing a minimum of basic services. With this independent group model, doctors can still freely receive patients who are not associated with HMO and are covered with other insurance plans.

There is also a group model known as a captured group. In this scenario, group practice is created for the explicit purpose of administration of patients with HMO. Doctors associated with practice do not accept HMO patients and receive their compensation in the form of monthly payments for each member of the HMO assigned their care.

In addition to these two group models, there is also a model of employees. With this approach, doctors are located in a facility owned and operated and are full -time employees. Instead of a monthly wage based on the number of patients assigned by doctors, each medical specialist is paid the salary.

in the course ofThe flight was the subject of HMO the subject of controversy. Proponents of this type of medical coverage note that in some cases the structure of most HMO organizations has led to a reduction in the performance of unnecessary procedures and treatment. In addition, the provisions on the annual test as a guarantee are also offered as one sign of a proactive approach that most organizations have HMO against medical well -being of the members.

HMO health insurance detective stories note that many plans provide a fixed monthly payment for each member assigned to a particular primary care physician. If there are very few associated physicians in the environment, this may lead to a single primary care physician flooded with a huge number of patients. The result is that the amount of time that a doctor can spend with each patient can be limited, thus affecting the quality of medical care provided.

While some of the initial enthusiasm for HMO health insurance in the United States somewhatIt cooled, this approach to health care remains a viable alternative. Several HMO health insurance companies remain in operation, most of them have improved the original model from the 70s, so some of the past years have no longer been introduced.