HMOs: Are They Right for You?

Today, even relatively simple medical procedures can run into the thousands of dollars. Many consumers are opting for Health Maintenance Organizations (HMOs) as a way to control their health care expenses. HMOs typically provide preventive care, such as office visits, immunizations, well-baby checkups, mammograms, and physicals.

If you choose HMO coverage, be aware that HMOs can vary widely. Know what to look for. The Better Business Bureau suggests you ask the following questions:

• Is there a large pool of physicians and a choice of specialists? Are you comfortable with the hospitals used?

• Is the HMO conveniently located - or do you have to travel long distance?

• Is it easy to get appointments - or do you have to wait a specific number of days before you can see a doctor?

• Will you see the same doctor all the time? Some HMOs may assign you to whomever is on duty. Others require selection of a primary care physician (PCP). This physician, called the "gatekeeper," decides whether you need further tests or a referral to a specialist. Since referrals are charged to the PCP's annual account, the system is designed to eliminate unnecessary tests and treatments.

• What are the provisions for care on weekends, at night or in an emergency?

• Who's financially behind the HMO and will it still be in business next month? (Some have gone bankrupt.)

• Is the HMO offered or backed by an experienced health care company?

• Ask specific questions relevant to your own health needs. You may want to know if the plan covers pre-existing illnesses or medical devices, such as wheelchairs and canes.

• If you travel frequently, find out if it provides out-of-town emergency care.

• Is there a policy on seeking a second opinion?

To find out if an HMO has any complaints against it contact the Better Business Bureau for a reliability report or your local consumer protection agency.