Managed care plans were put in place for one reason and one reason only, to keep health costs low. Normally this savings is for the insurance company; however it doesn’t have to work only one way. Just because you have an HMO (health maintenance organization) doesn’t mean your health care has to suffer. Using this article as a guide you can find a way to use the system to your advantage and get premium health care at the HMO cost. The major part of working the HMO system is finding the right Primary Care Physician.
When attempting to find the right primary care physician some things to keep in mind is their availability. In the waiting room, ask around on how long it took to get their appointments. If you are going to have to pre-schedule your care months in advance, this may be a concern. Another thing to inquire about would be how they handle their referral process. If you need further care from a specialist you will generally need a referral. It can make a huge difference if you are required to see your PCP to get a referral before you get to go see a specialist. If you have to see your own PCP first, you are paying double the copay! Some doctors have a phone system where you can obtain a referral over the phone. Find out what route you would like to go and discuss it with your potential provider. The final thing to ask about would be how they handle emergencies. A PCP should have some form of contact 24 hours a day seven days a week. Wither it’s a covering physician or an answering service, knowing ahead of time how to get a hold of your doctor when you need them the most will help you when your time is limited.
Something to take note of is that PCPs are paid primarily on something called capitation. Capitation means that they get the same amount monthly from the insurance company no matter if you come in ten times or not at all that month. One may call this a conflict of interest. I’m not saying that a doctor would ever do anything to jeopardize your health, but sometimes this could cause a doctor to require multiple visits to give you the information or care that could have been handled in one visit. Sometimes it is normal to wait on test results and then revisit your provider, however if this is happening again and again I would ask around to see if this is standard procedure. I once had a primary that while giving me a physical began to tell me that he thought it may be a good idea for him to be my wife’s gynecologist. Clearly, one could feel his primary focus, might not have been my health. Reasonably so, the next day I changed my PCP.
Finally and most importantly, make sure your doctor is someone you feel comfortable with. Although it may sound simple, if you at anytime doubt your doctor’s opinion go with your gut. It is your health after all. Most insurances cover second and sometimes even third opinions. Do not stay with a doctor because you are afraid about giving them a reason or an excuse as to why you are changing doctors. It is your health and your health care at stake. You can change your PCP without giving any reason at all. It has boggled my mind how many members stuck it out with doctors who they completely disagreed with simply because they did not want to tell the doctor they wanted to switch. This is not a requirement with any insurance I have ever dealt with so if you want to change for any reason at all, I recommend you do.
In closing, HMOs get a bad reputation for cutting corners on health care, however you can use some of this information to find a good match in a doctor and begin having great care at a beyond reasonable cost. Turning the tables on HMOs is not really all that hard, it’s really about knowing how your plan works and functions and deciding what kind of care you are really after. If you have any questions as to what is covered or needing help on where to start looking for a doctor I would recommend contacting your insurance and getting a list of names in your area. If you have a blue cross blue shield plan nearly all of their providers can be found at the Blue Card Hospital and Doctor Finder Although this site doesn’t have recommendations, blue cross does have a rigorous credentialing process to make sure their doctors do live up to the highest standard I have come across in dealing with insurances. Whoever you go with, know you are never stuck with a doctor. Even though you have a managed care plan you do have a say in how you are treated and cared for. Take control as needed but do not be afraid to ask for help.
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