What is an HMO, HMO health and HMO providers? An HMO health maintenance organization. An HMO is a comprehensive group of network providers or group of providers specialists that provide quality and cost effective health care services to patients within that group. You'll be assign an identification card and on that card will list your responsibility for co-payment, the name of your primary care physician and your group number. There are no claims to be filed and there is no deductible to meet. By seeing Physicians within that group the patient pays a minimal fee such as a co-payment and usually no fees for labs x-rays and no deductibles.

Managed care organizations have been around since the 1970s, it was developed on the concept of promoting and providing counseling on good health, educating patients on such matters as nutrition, exercise and ways to manage their health for e.g. hypertension, weight control, smoking cessation, drug rehab, and encouragement of annual physical exams and PAP test, breast exams and the likes and thus maintaining the cost of healthcare down.

Employers and insurance companies negotiated with each other and were able to provide the employee with low cost benefits. This also meant that employers can provide better benefits to their employees at affordable prices. These benefits are for health coverage only, an HMO does not cover Workers’ Compensation, or injury on the job. These injuries are covered under employer compensation plan for the injured worker. Usually the employer pays a portion of the cost and the employee pays the remaining which is known as a premium. As later explained the employee will be responsible besides paying his monthly premium, he will be responsible for a co-payment at the time of visit. This is usually minimal fee. An HMO is good insurance plan for families, and young individuals.


At enrollment you the client selects PCP (primary care physician). Your primary care physician manages all your health care needs. Your Health Care Physician will manage all your authorizations to specialists such as internal medicine, pediatrician, gynecologists, labs and all diagnostic needs. The patient is to see the doctors within that network only, if the patient sees a physician outside the network he will be responsible for the charges as you will not be covered.
To avoid claim denials read about pre-certification for medical necessity

Physicians enrolled and credentialed with an HMO, once approved are placed on our roster and patients would be able to select by location the physician of their choice. Physicians will get paid once they see the patients and they send in the claims to the HMO, Physicians can match what patient they've seen against the roster that is sent to them by the HMO. Physicians are paid also a monthly fixed capitation fee regardless of provided services for seeing HMO patients.