I know nothing about insurance!


New Member
Hey bigblue, I am switching my insurance to an HMO . I have asked many questions, but still don't know if I should. Rx's are cheaper---Dr. visits are cheaper---No deductible----100% paid after I pay the Dr. visit---They say no bills-----Do not have to have a primary physician to authorize specialist visits---
This sounds to good to be true. I've checked with our Dr.s and they accept this insurance.
My ? is I've only heard bad things about HMO's does the above sound normal or is it to good to be true? Lisa

Stella Johnson

Active Member
I am no insurance expert but I have never heard of an HMO that you didn't have to have referrals for specialists.

I had an HMO a few years ago. IT was much cheaper. I loved not having deductibles. difficult child wasn't seeing a psychiatrist then so I don't know how they are with psychiatric stuff.



New Member
many of the larger HMO's.........primarily United Healthcare and Cigna have done away with the need for referrals for specialist visits. They found they were approving the large majority of them anyway, so the expense of all the personnel needed to track them and put them in a system for claim payment just became an expense they could alleviate. That said, I would definitely ask for a Benefit Plan booklet which should have it spelled out for you in black and white. Next I would check on the amount of yearly nervous or mental health outpatient visits, as well as in patient days allowed. Next check for the LIFETIME max on these benefits, as they may max out much quicker than you would think. I would also check on the dollar amount for the office visits...sometimes you do have a coinsurance even with an HMO. Finally I would see if this HMO has a drug formulary that you have to follow for medications. If so, get it and take it with you no matter what type physician you are seeing.
HMO's are really not all bad. In fact due to new federal regulations, they are probably better than a lot of the ppo/indemnity plans as they have been mandated to do many specific things. The most important thing in most HMO's now to watch out for is in network physicians and facilities. They might even have an out of network provision, but you usually pay much more out of pocket. Most HMO's are usually sought out by employer groups with alot of claim payment in the past as a means to try to help cut costs, and most are under the fully insured regs, which means the carrier has the ultimate risk therefore makes the ultimate decisions on care and benefits. BLUE
PS I see you are here in Alabama too,so if you want to email me the actual HMO you are looking at I can give you even more of an answer. BLUE