How do I Choose the Best HMO Provider?

There are several contexts in which the term best HMO provider may be considered. An HMO provider could be a primary care physician (PCP), a company or broker that provides access to insurance, or varying HMO plans as might be offered privately or by a person’s company. These each require different considerations.

When the question arises about how find the best HMO provider as related to choosing a primary physician, it’s first important to determine who contracts with a particular HMO. Many HMO plans keep a list of doctors belonging to the organization and it might first be best to see if present doctors participate. Sometimes this isn’t possible, especially when people switch to a closed system where doctors only work for the HMO.

Closed system plans like Kaiser Permanente are usually fairly large, which means it’s a safe bet that people can ask among friends and family that might also participate in the plan who they would recommend. If leaving a trusted primary care physician due to changes in health plans, it also could be a good idea to get his or her recommendation. Doctors very often have professional and personal relationships with many of their colleagues and may be able to make several recommendations of associates. There are also many online websites that “grade” physicians, but these can be variable in their usefulness and depend on very small samples of patient reviews in order to determine a doctor’s worth.

Perhaps the most important ways to determine the best HMO provider in this context of finding a PCP is to do some interviewing of physicians after getting some recommendations. Find out what their hours are, how easy it is to get a same day appointment, if they have associates with which they work, and what their philosophy in medicine is. Knowing these things and getting answers to any other relevant or personally important questions can help determine which PCP seems best.

As to the other ways in which the term HMO provider may be defined, this may be a complex or simple business. In some circumstances, the question might be asked by heads of a company seeking to find the best plan for their employees. Usually, there is a dual consideration here: keeping costs low while providing good medical care. It should be noted that an HMO is not the only choice, thought it might one of the choices a company could offer employees who want a low cost option. Many employees do want more choice, and it might be best to find a broker or an insurance company that offers several options, like an HMO POS or a PPO.

Sometimes individuals may have a choice of several different insurance companies and HMO providers. This could be the result of belonging to programs like the State Children’s Health Insurance Program (SCHIP) or Medicare. In this case, each person may need to determine which HMO provider is best.

Some of the things to look for in determining quality of each insurance or health provider company are reviews of each one, which may be offered by state agencies. Another important consideration is how many present medical providers belong to the HMO. Is it possible, for instance, to retain current primary doctors and specialists?

Just as companies must consider cost, so must the individual. How much does the HMO charge per month, and what are the costs of copayments? Taking all of these into account may help determine which HMO provider is best.