HEALTH MAINTENANCE ORGANIZATION (HMO)

There are different types of health insurance policy that you can decide to go into to ensure safety in your health and these plans all come with their different benefit: In this article we shall be discussing about the various types of health insurance.

The Health Maintenance Organization (HMO) this common type of coverage generally requires you choose a primary care provider (PCP) to coordinate your care. In general you do not need pre-authorized from the insurance company to receive care in an HMO. HMOs often have lower insurance premiums because they focus on integrated, or coordinates, care and use the PCP to make sure that any testing or treatment as truly needed.

In the USA, a health maintenance Organization (HMO) is a medical insurance group that provides health care service for a fixed annual fee. It I an organization that provides or arranges managed care for health insurance self-firmed heath care benefit plans, individuals and other entitles acting as a lesson with heath care provider on prepaid basis. 

HMO is an organized public or private entity that provides basic a supplies mental health service to its subscriber. The medical entitles that enter into contracts with the HMOs are paid an agreed fee to offer a range of service to the times subscribers. The agreed payment allows on HMO to offer lower premiums than other types of health insurance plans while retaining a high quality of care from its network.

The insured must choose a primary care physician (PCP) from the network of local health care providers under an HMO plan. A primary care physician is typically an individual first point of contact of all heath related issues. This means that an insured cannot see a specialist unless PCP refers him/her to a specialist well contain things like screening mammograms, do not require referrals

In some countries, health maintenance organizations perform certain roles which may include:

1.     Provision of risk management enlightenment for those that enroll and providers

2.   Getting in touch with health care facilities that are only acquired by the scheme with the arm of providing health care services.

3.   To ensure that approval to referrals are done within the stipulated time and undertake the necessary follow up to complete the referrals.

4.     They also ensure that processing of claims is done efficiently.

5.     To ensure quantitative and cost effective health care serves to contributors through the   health care providers (HCPs).

           

And many others.

A glimpse how HMO works.

An glimpse develop its networks by contracting primary care physicians, specialist and clinical facilities, The HMO 2 agrees to pay these parties specific levels of compensation for a range of services they provide to its subscribers. In return for a monthly fee, or a premium, subscribers may access services outside the network with the HMO’s approval but may need to pay for part of the services

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