HMO is a health maintenance organization. HMO's come in different flavors but most share similar structures.
With most HMO's you have a PCP (primary care provider) that directs all your care, including referrals to other HMO network providers. In rare situations they will make a referral to a non-network provider.
Some folks don't like the "tight rein" HMO's use to direct your care. In many cases HMO's have a higher standard of care (vs PPO or POS) and better outcomes.
EVP Operations, Meridian Benefits consulting, New York
HMO is short for Health Maintenance Organization. Essentially, an HMO is a network of providers (doctors, specialist, hospitals, faculties) who have contracted with an insurance company to submit claims for visits and procedures given to the insurers membership. Typically an HMO will only pay for visits to doctors in their network and does not allow for services provided by doctors not contracted with them.
As a member of an HMO, your care is driven by a Primary Care Physician who usually acts as the first source of diagnosis. The are often called the "gatekeeper" because access to specialists services or high end procedures need to go through the PCP. The PCP will determine the medical necessity of the specialist or procedure and make a referral.
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With most HMO's you have a PCP (primary care provider) that directs all your care, including referrals to other HMO network providers. In rare situations they will make a referral to a non-network provider.
Some folks don't like the "tight rein" HMO's use to direct your care. In many cases HMO's have a higher standard of care (vs PPO or POS) and better outcomes.
As a member of an HMO, your care is driven by a Primary Care Physician who usually acts as the first source of diagnosis. The are often called the "gatekeeper" because access to specialists services or high end procedures need to go through the PCP. The PCP will determine the medical necessity of the specialist or procedure and make a referral.