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Health Insurance: HMOs (Managed Care Policies)

The Pluses And Minuses Of An HMO Type Health Insurance Plan

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Patient Out-of-Pocket Costs - This is the lowest of all plans in premiums. The insured usually pays no more than a co-pay per office visit such as $2.00, $5.00 or $10.00 which covers the entire visit including x-rays and lab tests. There are similar payments to the pharmacist for prescriptions. Most other services, hospitalization, radiotherapy, etc. are provided without cost to the patient.

Benefits -- HMOs provide more preventive and educational procedures and programs than other types of insurance. Also, HMOs claim their doctors practice better medicine because they are supervised by the medical groups and the HMOs they belong to. It's arguable whether they focus on quality of medical care or the lowest possible expense. 
Paperwork -- There is virtually no paperwork in the HMO system that the patient must complete. Any paperwork that must be done is completed by the HMO staff.

Easier Access -- While there may be delays with getting an appointment with your Primary Care Physician, most HMOs have their own or access to Urgent Care or Walk-In facilities to provide care quickly when needed.


Physician And Health Facility Choice --All treatment must be performed by a contracting provider in a contracting hospital except in life-threatening emergencies. Members lose freedom to choose healthcare providers and services.

Limited Choice of Treatment - All treatment must go through a Primary Care Physician (PCP) with that physician deciding when and if the patient should see a specialist and, if so, which one. Also, the patient cannot change PCPs without prior approval. Any charges incurred outside this closed network system are solely the responsibility of the patient.

Delays in Care -- Most procedures beyond the office visit to the PCP and some routine tests require preauthorization which can delay x-rays, specialist care, and more expensive treatments and procedures. While HMOs have made efforts to prevent unnecessary delays, any delay that occurs before a necessary test or treatment can be given creates unnecessary stress and aggravation. 

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