HMO's

HMO:  (Health Maintenance Organization) Health HMO’s are a form of Managed Care Organizations. The HMO agrees to provide health insurance coverage through hospitals, clinics, doctors and other providers with whom they have a contract, thus you are limited to providers that are contracted with your HMO plan. You must select a Primary Care Provider (PCP) who acts as the “gatekeeper” of your health needs.  He will be the first line of contact when you need to be seen or referred to a specialist or ancillary provider.  There are also “direct” referrals, which mean that he can give you an order for a service that does not need authorization or permission from your HMO.  This might be a lab test or simple x-ray.  Then there are the types of specialists or procedures that need “authorization” from your HMO.   When deciding to choose an HMO vs a PPO, make sure that the providers that you generally see are contracted with the HMO, otherwise you may have to establish relationships with a whole new set of medical providers.