What Is a HMO Insurance Policy?
HMOs, or health maintenance organizations, are one of many types of health insurances available to help cover health-related expenses.
A health maintenance organization pays for health care provided by members of a network of doctors and hospitals established by the company.
Group HMOs are offered through employers or associations for their employees or members and their families. The employer pays for part of the coverage. Individual HMOs are purchased directly from the provider by one person or a family.
HMOs typically require patients to choose a Primary Care Physician and then visit that doctor for care or to receive a referral for a specialist.
In exchange for the coverage provided by an HMO, it is necessary to pay a bi-weekly, monthly or annual premium, with group plans typically having lower premiums that individual plans. HMO insurance usually requires the insured to pay co-pays or fees when visiting a doctor or emergency room.
HMO insurance policies usually require members to pay fewer health care expenses on their own than other types of health insurance according to the Insurance Information Institute.
In some cases, you may be denied coverage by an HMO due to a pre-existing condition or an illness or condition that you have when you apply for coverage. Group policies sometimes feature open enrollment, which guarantees employees coverage despite their general health.
Medicare Guideline posts
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Top Medicare billing tips
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr...
Flow Cytometry is a highly complex process by which blood, body fluids, bone marrow and tissue can be examined. It provides important immun...
Procedure code and description 93015 (cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous ele...
Coverage Indications, Limitations, and/or Medical Necessity This LCD describes conditions under which the coverage of nail avulsion/ex...
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 36416 Collection of capi...
Molecular diagnostic testing, which includes DNA- or RNA-based analysis, with or without amplification/quantification, provides sensitive, ...
Procedure code and description 95004 Percut Tests w/ Extrac Immed React # Allergy testing - Percut allergy skin tests - Percutaneous ...
procedure code and description 93922 LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, (EG, FOR LOW...