North Fork Properties small business group health insurance

North Fork Properties small business group health insurance

The staff model. In staff type HMOs, the doctors are not equal partners with the plan but, rather, are employees of the plan. This means the plan has a lot of power (the power of an employer) over how patients are treated, since the doctors are hired as individuals and do not have the clout of a group behind them. Most treatment is don’t at plan-owned hospitals and clinics, and only plan doctors can treat plan  North Fork Properties small business group health insurance members. Doctors in staff type HMOs, like group systems, can only work for the HMO and do not have an individual practices.

The IPA Model. IPA stands for independent physician association. An IPA is a group of  North Fork Properties small business group health insurance doctors who, for the limited purpose of working with an HMO, form a legal entity that contracts with the health plan. In other words, doctors who are in private practice, and who cooperate with traditional health insurance companies, can at the same time be members of an IPA model HMO. However, unlike the referrals that might be made in a traditional health insurance situation, if the case comes to the doctor from the HMO, he or she can only use  North Fork Properties small business group health insurance plan-authorized physicians for referrals and can only hospitalize patients in plan contract hospitals.

Criticisms of HMOs

The recent expansion of HMOs into a significant force in the health care marketplace has created a controversy over the quality of care given by them. This is because the profit margin in an HMO is increased when the extent of medical care is decreased. Most complaints about  North Fork Properties small business group health insurance HMOs concern the following.

Insufficient testing. Some plan members complain that it is hard to get the HMO to adequately test them regarding their health complaints. Of course, traditional health insurance administrators complain that too much testing goes on.

Time delays. Some  North Fork Properties small business group health insurance HMOs are well known for the waits required both to get in to see a doctor and to obtain medical tests.

Difficulty in getting non-plan emergency room treatment. When we suddenly become ill or are injured, our first instinct is to get to the nearest emergency room, pronto. However, if you are an HMO plan member, you may not be able to get authorization for treatment unless the situation is a matter of life and death. When non-plan testing and treatment is allowed, it is often given piecemeal, requiring far more time in the emergency room than would otherwise be the case. Should you decide to go ahead with treatment without authorization, you may have to pay the bill yourself.

…Continued in  North Fork Properties small business payroll outsourcing