Think a health maintenance organization is the best kind of insurance for you? Now, you just have to figure out which one. There are several HMOs that operate in San Diego, and many employers offer a choice of two or three.
In addition to recommending that you talk to people enrolled in the plans, health insurance experts and the Agency for Healthcare Research and Quality suggest asking the following questions to find the right HMO.
How many doctors are there to choose from in the HMO network?
Is the HMO an individual practice association (IPA), in which the HMO contracts with health care providers who have private offices? Or is it a staff model HMO, in which the health care providers are employees of the HMO and work in one central clinic?
Is your physician (assuming you already have one) part of any HMO network?
If you know you or a family member will need to be cared for by a specialist, which HMOs include this specialist in the network?
Which doctors are accepting new patients?
How are referrals to specialists handled?
How easy is it to get an appointment? How long does it usually take to get in to see a primary care physician? A specialist?
What arrangements does the HMO have for handling emergency care?
Are there any limits on medical tests, surgery, mental health care, home care or physical therapy?
Does the HMO offer the particular services you need or want?
Where are the facilities that serve HMO members?
How convenient to your home or office are the clinics, doctors, hospitals and emergency care centers in the HMO network?
What happens if you or family members are out of town and need medical treatment? Will the HMO cover it?
What is the yearly total for monthly fees for the HMO?
What additional fees are there? What are the per-office-visit co-payments? Prescription medication co-payments? Extra fees for mental health care or rehab services?
