Health Insurance Articles
Open Ended Hmos And How They Benefit Health Insurance Consumers
2010-05-12
Most medical insurance companies allow you to choose between a Health Maintenance Organization and a Preferred Provider Organization. An open ended HMO basically gives you the best of both plans. HMOs require the patient to choose a primary care giver who can refer you to specialists within a network of medical providers. This approved network helps insurance companies to negotiate better rates for patients. If you seek medical treatments outside of this network, you will not be covered, unless it is for emergency treatment. A PPO allows you to use medical services and facilities outside of the network, but if you stay within the network, you will be charged less for the services.
Open ended HMOs allow a person with health insurance coverage to use providers located outside of the provider network and still be compensated either fully or partially for services, which is similar to a PPO. Although patients are permitted to use physicians or medical facilities that don't belong in the network, they still encourage patients to stay in the network. Knowing that in-network providers offer lower fees, insurance companies hope that patients will opt to stay in the network rather than seeking medical assistance elsewhere. People who have just been issued health insurance coverage with open ended HMOs must choose a primary care physician for their routine and basic care. This doctor must be chosen from a list of pre-approved providers. The primary physician may refer patients to specialists located outside of the network. But, if this happens, a claim may not necessarily be completely covered like it would be if a specialist from the network was used.
Other methods are used to encourage patients to stay within the network. For example, physicians usually charge to complete forms, but if you use an approved doctor in the network, they will fill out these papers for no fee. If you decide to visit an alternate medical provider, you will have to complete this paperwork yourself. You will also be required to provide copies of all bills, prescription receipts, and all other medical documentation. One of the best benefits that open ended HMOs offer to patients is the flexibility to use physicians located pretty much anywhere without being penalized. You may not be fully covered, but you will recover partial costs.
It is up to each individual to decide which plan best suits their medical needs and financial situation. An open ended HMO is your best choice if you are interested in low premiums and don't mind limited choices. If you normally use medical services from providers outside of your medical network, then you may want to consider researching open ended HMOs rather than a traditional HMO or PPO.
