What are things to consider when shopping for an HMO?
- What percentage of the plan's doctors are board-certified. How many leave each year?
- Has the plan been evaluated by the National Committee for Quality Assurance or another organization. Can you read the report?
- What is in the sample benefits contract?
- How many of the complaints against the plan filed with the state insurance department have been upheld?
- Must primary care physicians request permission from the HMO before they can refer patients to specialists? Does that rule extend to gynecologists?
- Is it easy or difficult to file an appeal when treatment is denied?
- Do doctors receive financial incentives for holding down medical costs? Are they willing to disclose them?
- What type of preventative care, such as immunizations and annual physicals, does the plan offer?
- Is preauthorization needed for hospitalization? What kind?
- Is a prescription drug you use on the plan's list of approved medications?
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