I have an HMO health insurance plan for my wife and I. I hear people say bad things about HMO's. Why is this

Question

I did some reading but from what I've read the difference is that the doctor get's paid differentlly with an HMO v.s. a PPO. My wife and I are doing well and get treated well.

Answer 1

I thought my doctor was an HMO, but turns out he was just really stylish and fabulous.

Answer 2

An HMO is a "Health Maintenance Organization". It is a group of doctors organized to provide health care at lower rates. Most HMOs are small, so selection of doctors can be an issue. There are also more regulations to follow to make sure that you retain your benefits, such as needing a referral to go see a specialist. This can cost you, because to get the referral usually requires a doctor's visit which costs you, just to get the referral.
A PPO is a "Preferred Provider Organization". In this system, individual doctors choose to take lower pricing for the PPOs referral to their practice. It is a more open system, requiring no referrals, but generally costs a little more than the HMO.
When you hear people say bad things about their HMO, it is usually because of one of two things. Frequently, HMO providers are overbooked because of the volume of patients that they need to see. This can cause long waits and frustration. Secondly, it can be a hassle to deal with the referral process.
HMOs are not inherently bad. Some doctors know how to handle the volume and some do not, so whether or not you are happy with an HMO greatly depends upon the doctor you have. If you are happy and are treated well, then there is no reason to change.

Answer 3

There is nothing wrong with an HMO plan. Some people don't like it because you can't make your own health decisions. If you want to see a specialist you have to get your primary care physician to approve this. If you want to change your primary care physician, you have to go through you insurance company. With a PPO you can see whatever doctor you want. However, usually HMOs have smaller copays and lower out of pocket costs. You usually pay more when you have a PPO plan and you have testing or procedures done.

Answer 4

From what I know the big difference is that with an HMO you have to be referred by your family doctor for any kind of specialist. Say you have a medical problem that requires you to see a specialist you have to go to your family doctor for a referral before you can see the specialists. I also think that more surgeries have to be pre-approved with an HMO than with a PPO. I have a PPO which works for me cuz I have to see specialists for different things alot and I don't want to have to pay my family doctor and my other doctor every time I have to go. If your someone who isn't sick alot then a HMO should be fine.

Answer 5

As long as you play by the rules the HMO sets, you'll have no problems. (Make sure you get your referrals before you see any specialists, etc.) It's people who try to get around the rules that have the problems. HMOs rely on Primary Care Physicians (PCPs) to coordinate care for patients - meaning, if you need anything, you need to see your PCP first, and since there's a great many people who "doctor shop" (if they don't like what Dr. A tells them, they go to Dr. B, Dr. C, Dr. D, etc. until they get the answers they like.) they try to get round these rules, and that's how problems are created.

Answer 6

I love my HMO. I have never had any problem getting referrals and their network of doctors is extensive. I have Coventry of Kansas. I have used them for 2 surgeries, ER visit, birth, and other standard checkups. It only cost me $285 to have my daughter!!

Answer 7

Can't please all the people, all the time. Some people just want Cadillac coverage for Yugo pricing. The "bad" thing about HMO's is that you have to use THEIR people.

That's not good enough for some people, but usually it's the SAME some people that don't want to pay higher premiums to go where they want, either.