HMO’s: A Simple Way Out of a Maze of Health Insurance Choices

The rapid advance of medical, pharmaceutical and diagnostic technologies has left a host of financial and human problems inadequately addressed. Regulators approve of new methods and medicine with increasing frequency and patents result in most of these advances being available at quantum jumps in cost to the Health benefit provider or the patient, if coverage is not possible. New disease detection methods involve genetics and bio-physics with the involvement of incredibly expensive reagents
and hardware.

The bludgeoning Healthcare cost to the economy has increasingly become a vital concern for all stakeholders. Health Insurance providers who work for profits have become increasingly wary of offering products with unlimited coverage. Lay people are left to decide on matters such as exclusions, co payments and lifetime limits that they do not understand in full.

Health Insurance coverage for children, the elderly and for women involves deep and extensive knowledge of a number of fields. Agents, doctors and other professionals who can apply relevant criteria to select a Health Insurance product that suits all members of a family are rare. Those who have a feel for the key nuances may not always represent the best interests of a potential client. It is entirely possible to pay an enormous premium for health services that are fortunately not required, but to be left without coverage for essential consultation, tests, hospitalization, surgery and medicines. Differences of opinion between doctors on new technology only confounds patients and makes decision-making ever more difficult.

One may go on at length on the inadequacies of the U. S. Health Benefits system, but it remains amongst the best and the envy of the world. There has to be an optimized answer to the riddles of Health Insurance and it may be said to reside in the form of an HMO or Health Maintenance Organizations. Networks of professionals and medical institutions get together under the aegis of a provider, to offer a package of comprehensive Health Insurance benefits at affordable cost. A primary benefit of the HMO system is the figure and person of a Primary Care Physician. This may be a General Medicine Practitioner or a specialist such as a Pediatrician. The Primary Care Physician acts as a kind of General Counsel for all Healthcare matters and decides on referrals that may be required. This may include reference to a specialist outside the network in case a patient’s condition requires this.

Customers pay an all-inclusive premium once a month or quarterly and can then sit back and leave all their health concerns to the Primary Care Physician. Co payments are typically small. Overall, an HMO delivers total care within tightly controlled financial outgoings. It is a simple and economical system and especially suits those with low interest in medical matters. HMOs do not absolve clients of all responsibilities-there are choices to be made on exclusions and co payments. People may not want coverage of pregnancy and childbirth related expenses at certain points of their lives. Those who pride themselves on fitness may want to pay low premium and opt for higher co payments if they unexpectedly fall ill. A professional Agent or a prospective Primary Care Physician can help take these decisions in a sanguine manner.

It is best to study alternate HMOs and to compare their quotes about a month before open enrollment. This helps to arrive at a judicious decision without time pressure and with full weight for all the technical and economic parameters involved. HMOs represent an important advance over the older Medicare system under which expenses for each specific act of medical care were shared between the provider and the patient or the family. HMOs provide greater security to people, facilitate deployment of cutting-edge technology to treat patients and result in all-round cost savings to boot.