Posts Tagged - ‘hmo’

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HMO Health Insurance Turns Off Pediatricians

Wednesday, May 26th, 2010

Image: isafmedia under CC 3.0

A recent essay in Newsweek discusses the plight of pediatricians. They are the first primary care physician most people have, and good health care as a child is one of the best ways to improve adult outcomes.

Unfortunately, managed care has caused many pediatricians to quit their jobs. The stress of fighting with managed care health insurance for reimbursement of their services gets to be too much. Justifying essential care to corporate bureaucracy ruined the joy of their practice.

When HMO health insurance providers decide to cut their reimbursement rates, pediatricians are forced to fill their days with more patients, which leads to longer wait times. Health insurance reform, which adds more patients to the rolls, may make the situation even worse.

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What Will HMO Health Plans Do Now?

Wednesday, March 24th, 2010

(Image: eMuse Tess Heder under CC 3.0)

HMO health plans are known for offering a comprehensive level of major medical coverage for a relatively low price. Unfortunately, they are inconvenient for many consumers due to their bureaucracies and requirements to see a primary care physician to receive referral for specialist care. As a result, these health insurance policies have been declining in popularity.

Healthcare reform may damage them further. Since health maintenance organizations are no longer allowed to deny coverage to people with pre-existing conditions, their main mechanism for keeping costs down and maintaining their profit margins has been taken away. They can increase premiums even further, but those actions will also be subject to more scrutiny and regulations. Granted, the brunt of that regulation won’t be fully in place for several years.

Consolidation is also an option. Another solution for HMOs is to cut their administrative expenses, which has its benefits and drawbacks. On the positive side for consumers, a higher portion of their health insurance rates will actually be spent on their health care, which should end up reducing premiums. The main negative is that the increased efficiency may result in some job losses.

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Does Managed Care Health Insurance Get a Bad Rap?

Tuesday, March 16th, 2010

(Image: jbcurio under CC 3.0)

In the early 1990s, managed care health insurance–including HMO health plans–were the main form of health insurance in America. On the positive side, they controlled costs, and inflation of health care expenses was lower when they dominated the system. However, they did not offer many patients sufficient control and flexibility. For those reasons, they have largely been supplanted by HSA, POS, and PPO plans that do not require receiving approval from a gatekeeper within the bureaucracy to receive care.

In many respects, that’s a welcome development. Recent studies from Harvard economists, though, claim that managed care’s negative reputation may be partially undeserved. Apparently, managed care patients are not any less likely to recover from diseases; nor do they have significantly shorter life expectancies. They also use electronic medical records and other innovations encouraged for other health insurance companies, while providing an alternative to the current fee-for-service system that helps make insurance more expensive.

Such a revival may work if there is an exit valve, which would allow people to go out-of-network to receive additional care for a separate fee.

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