When you join an HMO, it is important to begin the relationship in the best possible manner. The quality of services you receive from your HMO will be enhanced if you follow a few simple principles in dealing with it.
Checklist for Forming a Relationship with Your HMO
- Familiarize yourself with your provider agreement and HMO’s procedures
- Select your general physician
- Transfer all of your medical records to your general physician
- Learn the procedure for phone inquiries
Familiarize Yourself with Your Provider Agreement and HMO’s Procedures
The first task for you (and any members of your family) is to understand your selected HMO’s operating procedures. During your selection process, you should have reviewed the HMO’s operating procedures to some extent, but once you are utilizing a particular HMO, you must review its procedures in detail.
To use your HMO effectively, you and each covered member of your family must know what the HMO requires for you to receive medical treatment, how your general physician is used, what drug coverage is provided, what to do in emergencies, how to get care from specialists, how to obtain tests, and what preventive services (including annual examinations) are covered. You should also become familiar with the forms of treatment that are not covered by your HMO, as well as the forms of treatment for which coverage is limited. The first step in familiarizing yourself with these matters is to read your HMO contract (your provider agreement) carefully.
Select Your General Physician
Once you understand the basic operating structure of your HMO, you should begin your relationship with your general physician. If you have selected your HMO because the general physician you (and possibly your family members) have been utilizing is on its approved list, this will be much simpler. If not, you should carefully select your general physician from the HMO’s approved list. Ask questions of others whose opinions you respect, and meet or at least speak with each of the general physicians you are considering.
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