Understanding Health Maintenance Organizations



Posted: Thursday, November 19, 2009

by Julie Newman

What is a health maintenance organization and what does it do? To get the whole picture you need to know that they were created originally during the 70's because of a government mandate that said any business with a certain number of employees had to provide health care for their workers. It is a managed care health plan.

A doctor or clinic will agree to become a part of the HMO. They have to go along with the regulations of that particular HMO and that t way they are guaranteed a certain number of patients. The doctors generally get less money, but more patients. That is the main reason why doctors sign up for this, because they will always have plenty of patients.

The people that are in the program will pick one doctor to be their regular. This will be the office that they go to before doing anything else. This doctor has to approve all other specialists or anything else that takes the person out of their office. Some people think that this can only be a general practitioner, but it can be something more specialized if you need it.

The HMO has a lot of rules and your doctor will get looked at occasionally to see if he is treating people according to the guidelines. HMO plans are known for doing preventative care. They realize that if illnesses are caught early on then they are easier, and cheaper, to deal with. They will not approve any elective types of procedures though.

There are certain HMO plans that are considered open access and they make it easier to get care from other doctors. Using HMO care is inexpensive and that is the main reason that people use it. The guidelines are hard to deal with for many, as well as the fact that they will not authorize any type of experimental care or procedures.

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