Health Insurance Articles
The Importance Of A Good Primary Care Physician In An HMO
2011-09-19
One of the most important individuals in establishing the value of an HMO health plan is the policyholder's primary care physician. Every health maintenance organization establishes primary care physicians for health plan members, and a good physician can make an HMO well worth the money. Conversely, a poor physician can make it very difficult to find appropriate care, especially when a patient has serious medical issues that require testing, treatment from specialists and other out-of-network services.
A good primary care physician is the first individual that a policy holder can see for any type of medical issue under a traditional health maintenance organization. Specialist physicians have to be referred by the primary care physician under most health maintenance organizations; the patient can't simply visit a specialist, as the resulting claim won't be paid in full by the patient's health plan. In some cases, the claim may be outright denied. Likewise, the primary care physician will have to OK any surgeries and other treatments. Coverage can be severely restricted by an inadequate primary physician, as a policy holder will be unable to find a way to get coverage for various tests and treatments.
Insurance buyers should carefully evaluate their options when looking for a primary care physician in order to avoid a difficult health care situation. Many HMOs will list information about the physicians in their networks, and some larger health maintenance organizations allow policy holders to choose between several in-network physicians. Many of these physicians are pediatricians and they'll serve as a sort of "family doctor" for the insured. Well-qualified physicians who are willing to make appropriate recommendations and OK necessary tests and treatments can be extraordinarily helpful in improving the value of an HMO health plan. Unfortunately, many policyholders need to actually start a policy in order to evaluate their physician, but health maintenance organizations will often provide a guide to their in-network doctors that makes the process easier and allows policyholders to easily choose a qualified physician.
Another option is to choose a health plan from a preferred provider organization (PPO). PPOs have a number of advantages over HMOs, particularly in the way that out-of-network services are covered. PPOs cover visits to specialists as long as the visits are medically necessary, and while patients will often have to pay a slightly higher co-payment, they have much more control over their health care. An HMO can still be a solid and valuable health plan, but patients who are concerned about primary care physicians and who want more control over should look into PPOs for a combination of affordable care and low health insurance costs.
