What is HMO medical health insurance?
Reader question:
What is HMO medical health insurance?
Miriam
I’ll tell you.
The main benefit of getting an HMO, or health maintenance organization medical health insurance plan, is that this most popular of employer provided health insurance plans also tends to be the cheapest medical health insurance plan. It’s more designed for group health insurance, which is why it finds such popularity among companies insuring their employees. HMO medical health insurance is also one of the few health insurance plans that puts a lot of emphasis on preventive care.
The reason they put so much emphasis on preventive care is because, the way HMO sees it, is that preventive care can help reduce risks in an insurance pool by decreasing the likelihood that its members will develop a medical conditions, and thus it reduces medical costs. That is why it is the best to help someone stay healthy, not just to help them out if something goes terribly wrong.
The Good:
- The main thing is preventive care, which lowers both their costs and yours. HMOs also require less paperwork, and when you make a co-payment on something it will cost far less than it would with another medical health insurance plan.
- The insured under a health maintenance organization just pay a little fee each time they go to the doctor, and that is considered their co-payment.
- The coverage goes wide, with such things as outpatient services, extended medical treatment, short term mental health treatment, hospital stays, and emergency room visits.
The Bad:
- Picking and choosing the physician that you go to isn’t as easy as with traditional indemnity. Instead, you are only able to pick one provider, and that is who you must go to once he is listed on your insurance.
- The doctor you must pick has to be within the HMOs network. If you go to a hospital or physician outside of the network, then you won’t be covered at all.
- If you want to go outside of the network to see a specialist and still be covered, then you have to have a referral from your primary care provider.
Cheers,
Fashun Guadarrama.
What is traditional medical health insurance?
If you want to get traditional indemnity medical health insurance, also called FFS or fee for service medical health insurance, then you’re going to have to like paperwork. That’s why I’m including this video of a cute baby kitty in this post. Because, naturally, thinking of adorable kittens makes any distasteful action funner. Well, that might be overselling it a little bit.
Regardless of the extra amount of paperwork required, fee for service medical health insurance isn’t all that bad. It does cost more, with both more pricey monthly premiums as well as deductibles that tend to be on the high end, but at the same time it is a lot more flexible than many kinds of medical health insurance plans. If you’re willing to pay a little extra money and spend a little extra time for a lot more freedom and choice, then traditional indemnity medical health insurance might be the best option for you.
The Good:
- Lots of flexibility, in that you can pick what doctor, specialist, or hospital you patronize instead of having to choose out of a network and having to get a referral to go outside that network. It helps you take control of your medical experience and handle the way your health is going more than other, more controlling plans.
- No referrals, again. If you have to go to a specialist, you don’t have to worry about getting denied by the primary care giver that your insurance company picked for you. You can choose on your own.
The Bad:
- If you want the medical health insurance company to pay for the health insurance claim, you have to pay the deductible first, and this often is high. Also, after you have paid the deductible, you usually have to co-pay. Although the insurance company tends to pay around eighty percent, you still have to pay the other twenty.
- Your medical health insurance doesn’t cover your needs right away. Rather, you have to pay first and then file a health insurance claim to get your money (most of it) back to you.
- Traditional indemnity medical health insurance decides what is the normal price for a medical service, so if you go to a physician that is more expensive than others around the same area, then you’ll have to pay that extra money because the insurance won’t cover it.
Cheers,
Fashun Guadarrama.
Don’t get your health insurance claim denied!
Health care is expensive, which is why one of the most important things you must do to protect both your health and your assets is to get medical health insurance coverage. Without this, you’ll end up responsible for many high medical bills that you probably can’t afford, which will put you deep in debt and ruin your credit. But just getting medical health insurance doesn’t assure you of always being covered. The darkest aspect of the medical health insurance industry is that your health insurance claim can be denied, even when you need the coverage the most. For this reason, you must be very careful when getting medical health insurance coverage and step through the claims process with care.
I found a funny, kind of weird video on YouTube that I think illustrates this very well. It’s a cartoon of a bunch of pirates (who are actually health insurance providers) singing that you should go ahead and die because they won’t pass your health insurance claim. It’s cute and hilarious, in a silly way. Check it out.
Getting your health insurance claim denied can take a lot of people aback. A lot of times, it has nothing to do with and it’s done for a reason that you can’t control. Many, though, you can take charge of by controlling your policy and your own actions. Sometimes a health insurance claim will be denied because the insurer doesn’t have all the information that they need. You might be able to get the claim approved after you already paid, but that doesn’t help when you don’t have the money in the first place and a refund isn’t an option. Always submit complete information.
If you document everything concerning your medical care and medical health insurance, this is also a great way for dodging denied health insurance claims. Hold on to all of your paperwork and hospital and primary care provider information, because if your health insurance claim gets denied, you’ll have this to back up your case.
A lot of the time a health insurance claim will get denied for a reason you would have known about if only you had been knowledgeable about your plan. Read your policy, be thorough, and study your health insurance plan book so that you don’t fall into the trap of ignorance that could end up costing you a lot.
Cheers,
Fashun Guadarrama.