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5 HMO Traps To Watch Out For

Guest post by: John Clark

Article Overview: HMO insurance policies can be a nightmare to manage, let alone understand. Not only are they full of things that the members cannot do, but they are very strict on what doctor the patient can see and when the patient can see that doctor. While this is very frustrating for the patient, there are 5 pitfalls to look out for when dealing with an HMO.

5 HMO Traps To Watch Out For

HMO insurance policies can be a nightmare to manage, let alone understand. Not only are they full of things that the members cannot do, but they are very strict on what doctor the patient can see and when the patient can see that doctor. While this is very frustrating for the patient, there are 5 pitfalls to look out for when dealing with an HMO. Doctors and Hospitals who are out of network should be considered out of reach. Regardless of whether you have been seeing your previous doctor for your entire life, if they are not within the HMO's "network" of doctors, they will be too expensive for you to continue to see. If this is the case, take the HMO's directory of providers, which is what they call doctors, to your trusted physician and have them pick a provider for you that they know and can vouch for. You do not need to be experimenting with HMO providers when it comes to your health. The HMO chooses providers who will give them a discounted rate that will not go up, in most cases. If you insist upon going to your previous doctor, you will be paying out of pocket. The HMO will not reimburse you. The cost of these visits could be 400 percent more than what you would pay with the HMO doctor.

If a preexisting condition is something that you have, switching insurance companies is unwise. You may not even be approved for coverage, let alone have coverage that you can afford. If anything, attempt to get the condition fixed, if at all possible. If your coverage will expire and will not be reinstated, attempt to fix the condition within the time frame that you still have the coverage for. That may seem like a monumental task, but the bills from an HMO with a preexisting condition could wipe you out financially. Do not attempt to lie to them about anything that you have been treated for. They will pull all of your medical records and know anyway, so just be upfront about it and tell them how the treatment is going. If it is working, they may be persuaded to continue funding the treatment.

Requiring a referral to see a specialist is one more way the HMO's insure they are saving as much money as possible. If you do not have a note from your provider doctor stating that you need to see a specialist for your specific problem, the specialist will bill you directly for the appointment and any other fees involved in what they did with you. Getting a referral from your provider is relatively easy. You simply need to make an appointment with them and explain what the problem is. If they cannot help you, they will send you with a referral to the specialist. Then, the HMO Company will pay for the visits instead of you.

Waiting for the policy to start is another pitfall of HMO's. This could be anywhere from 4 to 6 weeks from the time that you are approved for coverage. If you have a medical emergency, there really is no choice but to treat it, insurance or not. However, if you can be patient and wait until the insurance policy begins, then you will save yourself a lot of money and frustration.

Family policies can cause problems as well. You may assume that your family members would have the same amount of a deductible as you would have, but it is typically 1.5 more that what you have. So, if your deductible is $2000, your spouse's would be $3,000. Be certain you know exactly what the prices are before signing a family member up with you.

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Article Tags: heatlh insurance, insurance policies, insurance rates
Referred by: http://www.franchisefix.com/



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