we are trying to find a pediatrician in our town, they accept our health insurance company but then they ask are we HMO or PPO and we are HMO, they say they do not accept HMO... i was wondering what the friggen difference was...please help!
Sure! HMO's plans rely on you having a PCM or primary care manager. This term may vary from plan to plan but basically it means that there is one person who decides and is in charge of and organizes your care. It means that your pediatrician (or internal medicine, family doctor, etc) is the person who would refer you for specialty care and would help you maintain your health. HMOs are usually based around preventative medicine. They are usually heavy on patient education but they often do not reimburse as well as PPOs (not your concern obviously but could still cause certain doctors to not be able to accept them- also I believe they are harder for doctors to get contracted with) PPOs do not require a referral. If you want to see an ENT- you simply go to an ENT. But HMOs often require more paperwork for pediatricians because they must make referrals and coordinate care.
Answer by CooksWife at 2:12 PM on Sep. 29, 2009
Answer by Anonymous at 2:06 PM on Sep. 29, 2009
Answer by danette624 at 2:09 PM on Sep. 29, 2009
Answer by danette624 at 2:27 PM on Sep. 29, 2009
Well you would need a family doc for the adults but the ped can be the primary for your children... Or your children can be seen at a family doc with you guys. We had a DO that was a family doc with our HMO but they couldn't do vaccines in the office so I switched the kids. Each doctor (this is just on their end) has to apply for a contract to accept insurance companies. The insurance company then decides if they want to accept the doctor. That credentialing process can take a long time... Again, another reason why some docs aren't able to accept certain insurances. You, under an HMO would always have the same PCM but depending on the type of plan/location may have your OB listed as your PCM until after you deliver. You may want to ask your insurance company about that. In short: If you want your whole family at one place you will have to find a family med practice and not a ped :)
Answer by CooksWife at 3:15 PM on Sep. 29, 2009
Answer by CooksWife at 3:18 PM on Sep. 29, 2009
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