What is an H.M.O.?

Question

I've looked it up but I just don't get it.

Explain this to me like i'm a 6 year old please.

Answer 1

An HMO is a health care organization created in an effort to lower health care costs for you and for whomever is helping you pay for your health care, such as an employer or the government. If you join an HMO, you get to use their services at a very low cost, much less than if you went to the doctor and paid for them.

HMOs are also appealing to those who pay for health care services, because HMOs are usually large organizations that can buy services for thousands of people and, at the same time, decide what type of care they will receive. Both of these allow HMOs to lower the cost of health care and give companies cheaper health care rates for their employees.

While all HMOs will provide you with written material about how their program works, they all have a few things in common. They all require you to use doctors and hospitals that are "in-network" or part of their HMO plan. Your HMO will provide you with a list of in-network doctors. Also, HMOs usually require you to choose a primary care physician who will be in charge of your health care. If you need other types of care, such as seeing a specialist or going to the hospital, you are first required to get approval from your primary care provider.

The most obvious advantage to belonging to an HMO is cost. First, the premiums of managed care are usually lower than traditional health insurance, which can end up saving you money if you are now paying any of your own insurance costs. Secondly, HMOs and most other types of managed care do not require that you pay for your medical care up front, so there are no claim forms to fill out or waiting periods for repayment. Lastly, many HMOs require only a small co-payment for a visit to the doctor, a hospital stay, or a prescription. This is far less expensive than the usual 80 percent reimbursement of traditional health care insurance.

But there are disadvantages as well. What most people dislike is the requirement that you use only doctors and hospitals that are part of the HMO plan. Also, HMOs operate on the concept of capitation — they receive a flat fee each month for each person they cover. While this creates a good mechanism for cost control, it can also lead to restrictive practices such as difficulty in assessing specialists or special drugs. If you do need specialists care, an HMO will require that you first get approval from your primary care physician, which can be time-consuming and difficult for someone with cancer.

Answer 2

Health Maintenance Organization

It is a group of doctors who have agreed to see patients for a fixed price (in order to control the cost of medical care).
The organization has the objective of preventing illness more than treating illness with drugs and medical procedures, so checkups and office visits are fully covered and encouraged.

However, the premiums for HMO coverage are typically higher than other group plans. If you are single and healthy with no children, your insurance premiums and deductibles will probably be lower with other group insurance coverage (non-HMO).
If you have a family with young children who may require more frequent medical care, an HMO may work better for you.

The downside of an HMO is that you can only see their doctors in their clinics. It is NOT in the doctor's financial interest to remain in an HMO environment since they just work for a salary rather than being able to charge more money for medical services that is their specialty. So, you lose choice. For ordinary procedures, probably not an issue.

For any procedures that the HMO does not offer, they will be very reluctant to refer you to someone not in the HMO, since the HMO will have to pay market rates to someone not in their group. You will also have much more approvals to obtain from HMO management before you will be allowed to go outside the HMO for service and have it covered by HMO insurance.

You should probably compile a medical history for your family (or yourself) and contact the HMO representative for an estimate of what your annual costs would be and where service would be delivered.

Answer 3

Homeopathic Monitors Office

Answer 4

this looks like it could be a H ealth M aintenance
O rganization. that is a type of medical insurance or clinic that helps control your medical care.