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Health Maintenance Organizations (HMO)

Here’s how HMOs work: You select a provider in your area, and you choose a primary care physician (PCP) from a list of doctors within the HMO network. That physician is the one you see first when you have medical issues, and for typical circumstances such as annual exams and usual health issues.

If you need to see a specialist, be hospitalized, or have lab or X-ray work, your doctor will refer you to a provider or facility within the HMO network.  Your doctor must give authorization for those services to be covered by your HMO. In other words, you must see HMO approved physicians and use HMO approved facilities or pay the entire cost of the visit yourself.

You may have to pay some portion of the cost (co-payment) for each doctor or hospital visit, regardless of what the services cost.

An HMO is an insurance plan that requires the insured to obtain their medical care from providers within the HMO network. By coordinating all doctors and patients within the same system, costs are kept down.