HOW TO CHOOSE THE BEST HMO

Mar
24
2009

Here are some tips for choosing an HMO.

(1) Will you be penalized for going outside the network of approved doctors? If so — how much?

(2) How much does the plan pay? Does it pay a percentage of the actual medical charges or of the allowable charge? There could be a big difference between the two.

(3) Talk to a few members of the HMO. Find out if they are satisfied with the service, cost, and speed of payment?

(4) What happens when you see a specialist who is not part of your HMO? Must you be referred to a particular specialist by your doctor?

(5) What medical services are not covered by the HMO plan?

(6) Check out the doctors on the approved list. Are they reputable? Do they have plenty of experience? Are there a lot of complaints against them?

(7) How much notification must I give the plan before going to a hospital or when an emergency occurs? Many plans require approval before the medical service is performed.

(8) How good are the services provided by the doctors who belong to the HMO’s. How fast can you get an appointment? Can they answer your questions quickly?

The best way to find out about a particular HMO is to talk to several of its members and doctors. You should also talk to the Better Business Bureau and find out if many complaints have been lodged.

A recent magazine survey rated 46 HMO plans. The top five plans were: (1) Heritage National Health Plan (2) Pilgrim Health Care, (3) Independent Health (4) Blue Choice (5) Preferred Care. Of course these plans may not be available in your area. Also the quality of service varies from one region to another. Therefore you must do a thorough study before committing yourself to any particular plan.

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