Another disadvantage of being in a health maintenance organization plan is when the member’s primary care physician decides to get out of the network. It is important for a patient or member to have a primary care doctor who can monitor his or her health regularly. As well, building a relationship with doctors are very important because of trust issues. When the member’s primary care doctor goes out of the network for some reason, the member will have problems finding another physician whom he or she can be comfortable with again.
One more disadvantage that a health maintenance organization can have is when it goes out of business, which can leave members without any health care. This would be an alarming situation, as many people rely on their health maintenance organization plans for medical services. Also noted is that most surgeries, like plastic or elective, are not covered by health maintenance organization plans. Health maintenance organizations also require utilization reviews for certain services or prescriptions.
This is done to know if the prescribed treatment is necessary for the patient, with consideration for his or her medical and personal history, and present status. When deemed unnecessary, the coverage will be denied and will cause problems to the provider and patient. At times, it will cause delay in the patient’s health care. It will also make the provider to ask for second opinions and generate another utilization review, which will cost more. Utilization reviews are usually done by health practitioners including doctors or nurses.
It is indicated that a lot of health maintenance organization plans give the most consistent, predictable costs, in contrast to other health care plans (BAA Health Insurance Services). It is effective in that it does not have hidden charges and whenever there are charges that has to be paid out of the member’s pocket, the member can always be sure that it will only be minimal. Its effectiveness can also be seen in less hospital patients and more clinic patients because people prefer going to clinics for check ups rather than waiting in line at hospitals. Because of this, preventive medicine is being practiced.
This is important because early detection and diagnosis can contribute a lot to a person’s health. Many people prefer health maintenance organization because of its availability. Because it has more advantages than disadvantages, it is better to obtain a health maintenance organization plan. Solutions for the disadvantages can be made, like having the member suggest to his or her preferred physician to become a member of the network. With all of these things accounted for, it will still be the discretion of a person if he or she wants to avail the benefits of a health maintenance organization.
It is admitted that health maintenance organizations have been a great contribution in health care. It has made medical treatments within reach to everyone. Although disadvantages can be seen, they can be considered as very minimal compared to what health maintenance organizations have to offer. An individual does not have an excuse for not obtaining medical treatment when there are numerous health maintenance organizations for him or her to become a member of. Medical care should also not be as complicated as it seems.
This is what a health maintenance organization can offer its members. Services are organized and are therefore less time-consuming. A person’s health should always be taken seriously. Health care should not be as expensive as others want them to be. It should be available to everyone without consideration for age, gender, race, or status. Anyone should not be refused medical service. Although that is the case, a problem will still arise if a patient does not have any means to pay his or her medical bills.
That is why it is always a good idea to be sure of one’s health, and this is what health maintenance organizations are for. Although it is made for everybody, health maintenance organizations are perfect for those people who do not need specialized medical care that can only be obtained through an out-of-network provider. There are other health insurance plans out there that one can choose from. When a person has the option to choose what health care organization he or she can avail, it is advisable to research about all the health maintenance organization plans available in his or her area.
The person should weigh out his or her options, as well as think of the best plan that his or health status suits best. One should also review the benefits that a certain health maintenance organization plan has to offer, the health care providers and medical facilities it covers, how easy or hard it is to get referrals, number complaints that the health maintenance organization has had, and most especially the quality of its service. Whatever a person decides to choose is actually better than not having any health insurance.
It should be remembered that our health should be one of our main priorities. It should never be disregarded just because of monetary issues or even any other issue.
References America’s Health Insurance Plan. (2004, July 21). Health Plan Links. Retreieved February 22, 2008, from http://www. aahp. org/Content/NavigationMenu/About_AAHP/Who_We_Are/Health_Plan_M ember_Links/Health_Plan_Member_Links. htm BAA Health Insurance Services. HMO 100% Provides Most Effective Coverage. Retrieved February 21, 2008, from http://www. baahealth.
com/hmo_100%25_provides_most_effective_coverage. asp Dalton, James. (2007, September 22). The Advantages and Disadvantages of PPO’s and HMO’s. Retrieved February 21, 2008, from http://www. freearticlesarchive. com/article/The_Advantages_and_Disadvantages_of_PPOs_an d_HMOs/31764/0/ Medicare. What is a Medicare HMO? Retrieved February 21, 2008, from http://www. medicarehmo. com/mchmwhat. htm Small Business Solution. HMO Advantages Disadvantages. Retrieved February 21, 2008, from http://www. residual-rewards. com/hmo-advantages-disadvantages. html.