HEALTHCARE SERVICES PROVIDERS

Healthcare Services Providers

Healthcare Services Providers

HMO (Health Maintenance Organization)

An HMO is a private Corporation which contracts with doctors, hospitals, employers and provides them coverage for individual health insurance in exchange for a fixed fee or premium. The individual bound to choose a primary care physician within the HMO network, through which all decisions made on health care (medication, hospitalization, tests and transfers to specialists).

The term refers to an HMO insurance model. The insured agrees to effective by reading the same HMO medical center when ill, except in an emergency. This structured doctor called gatekeeper or guardian. Emergencies, exceptionally, are not subject to this requirement, and preventive gynecological examinations and consultations eye (Gapenski, 2007).

The principle of "gatekeeper" is to coordinate the treatment of patients by a medical HMO. In addition, reimbursement on a fee basis allows the HMO doctor to prescribe only necessary treatments because there is no incentive to increase the number of medical benefits. Insured HMO premiums are up to 25% lower than those of standard basic insurance while providing the aforesaid services. Itis observed that many employers offer employees a plan for health care through HMOs.

Advantages of HMO

HMO offers the following advantages to its subscribers. It costs very low which is within the reach of your budget. Covered often have requirements and other "extras."

HMO Limitations

This type of plan would allow doctors to look beyond the HMO network.

The choice of hospitals is limited - If a hospital is not part of the HMO network, you would have to bear the entire cost if it is not recognized.

HMO Physicians are often limited in the type of care they prescribe due to the HMO's emphasis on minimizing costs. Many patients have registered in the indictment litigation to HMO relative lack of attention necessary to reduce costs. Inquire carefully about your employer's plan.

The HMO doctor receives a monthly lump sum to care for insured registered with him. This package covers all care received by the insured HMO, theydelivers to him by the doctor, or by specialists in a hospital (Dunn, 2006).

Emergencies

In an emergency, the insured HMO always first address to his HMO doctor. If it cannot be reached or if the insured is neither at home nor at his place of work, he will address immediately to the nearest doctor. Once provided emergency care, contact the insured HMO doctor and decide ...