Problems With HMO Plans
A Health Maintenance Organization (HMO) is a form of managed healthcare in which the insured sees doctors and specialists that are part of a network. This usually results in the insured paying a lower premium and not having to pay a deductible. While an HMO may offer the advantage of cost savings for the insured, there are also potential disadvantages.
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Limited Choice
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One drawback of an HMO is that the insured is limited to seeing only doctors within the network. If the insured wishes to see a doctor outside the network, there may be no coverage at all, so he would have to cover the cost out-of-pocket. This could be especially problematic if the insured has a medical condition that only a few specialists are able to treat.
Waiting
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Because the network is limited, a long waiting period may be necessary to obtain an appointment with a doctor. This differs from an indemnity plan, which allows for complete freedom of choice regarding doctors or hospitals. When a health situation arises that may require immediate attention, with an indemnity plan the insured may be able to make an appointment more quickly.
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Prevention
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An HMO may be a disadvantage for people who are not proactive when managing their health. Since the HMO requires a flat fee per doctor visit, if the insured does not seek help early on for a medical condition, it may prove quite costly if repeated visits are needed later. For this reason, the insured should have the mindset of prevention by maintaining a healthy lifestyle.
Emergencies
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The definition of an emergency can vary depending on the HMO. In most cases, the list of emergency conditions is less extensive with an HMO than with a traditional indemnity plan. This may cause insureds to hesitate when deciding to seek treatment for a condition, which could result in a potentially life-threatening situation.
Changing Doctors
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Many people develop a rapport with a particular doctor. If that doctor drops out of the HMO, the insured could be faced with the dilemma of deciding whether to see a different doctor within the network or to continue to see the same doctor and pay the cost out-of-pocket. This could result in the insured seeking new coverage, which can often be difficult to obtain as well as more expensive.
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