HMO Restrictions

Medical insurance is a necessity that can help improve not only the quality of life for the insured, but protect their financial resources as well. With medical insurance in place, individuals are more prone to see doctors regularly for preventative care as well as not putting off seeking medical attention when they need it. Additionally, health care insurance can provide an important financial cushion for those who need to really take advantage of the medical system. With medical insurance, financial ruin due to medical expenses can be avoided.

For those who are seeking an affordable yet good quality level of medical insurance, a Health Maintenance Organization (HMO) might do the trick. Under an HMO, there is a service network system compromised of participating doctors and hospitals.From the insurance company’s perspective, they can more easily control the costs of medical care that their patients seek, thus making the overall cost to be covered by an HMO plan lesser then other insurance options.

HMOs Offer Little Freedom

Aside from being affordable, HMOs are also known for being the most type of restrictive health insurance. Some HMO restrictions are:

  • Members of an HMO must choose a primary care physician (PCP) who then becomes the main point of contact for any other services offered through the health network
  • If a patient is interested in seeing a specialist within an HMO system, they must first get a referral from their primary care physician
  • Except for emergency care, members of an HMO are expected to seek all their medical attention from within the network and no compensation will be made to offset the cost of out of network health care

If however, you feel like you can work within the restrictive nature of the HMO health care system, then you can benefit from the care they provide. Some HMOs have large buildings with almost every level of medical care on site, thus making it easy to get a blood test, physical and appropriate medication in one day. Most importantly, HMOs are extremely focused on preventative medicine as it will help ensure the health of the patient while lowering the overall cost the insurance provider will have to pay out of pocket.