Why Primary Care Matters in an HMO Plan
Primary care physicians coordinate care in an HMO
Primary care physicians coordinate care in an HMO
Choosing the right primary care physician for you and your family is important. This choice is even more crucial if you have a Health Maintenance Organization (HMO) plan.
HMO plans usually require you to select a primary care physician (PCP) from your HMO network. This doctor can be a family practice doctor, an internal medicine physician or a pediatrician.
In an HMO plan, your primary care physician is the primary point of contact for health-related issues. They are your first line of defense when you are sick or need treatment and can refer you to a specialist if needed. They also provide preventive care, such as routine screenings, checkups and flu shots.
“Primary care doctors are the quarterback of your health care team,” says Scripps Clinic vice president of primary care and internist Siu Ming Geary, MD. “If you develop a serious condition that might require specialists, your primary care doctor can ensure that all appropriate care is given and there are no gaps.”
Care coordinators
Having a primary care provider who knows your health history can improve your care. They can help manage ongoing health issues and support you with new ones.
It’s important to keep communication open and honest. Your relationship with your primary care doctor may last longer than jobs or friendships. So, take the time to get to know them well.
“We form relationships with patients over many years, so we know their health history,” Dr. Geary says. “We can take care of them physically, and also mentally. And if a physician takes care of multiple family members, there’s an even greater impact from our lifestyle and health recommendations.”
Pros and cons of HMO
HMO plans usually have lower premiums and deductibles than other health insurance plans. However, they often do not cover care outside the HMO network, except in emergencies.
Most plans must cover basic services, including preventive care, hospital stays, lab tests and prescriptions. However, you should check your insurance documents or check with your agent, especially for prescription coverage. While many plans usually cover generic prescriptions, they often cover only select brand-name prescriptions and the cost for prescriptions that are not covered may be significant.
HMO plans can lower your out-of-pocket costs. However, they offer less flexibility than preferred provider organizations (PPOs).
PPOs give you more choices, but they often have higher costs. You generally don’t have to get a referral from your primary care physician to see a specialist. You can see specialists both in and out of the network, although seeing a physician out of network will cost more.
Point of service (POS) plans combine aspects of an HMO plan and a PPO plan.
Finding a primary care physician
There are many reasons you may need to find a new doctor. You may have moved, changed jobs or turned 26. You could also be unsatisfied with your current doctor and wish to change providers. You may want to explore another type of health plan because of changing circumstances.
Selecting a primary care physician is essential, whether you're enrolling in an HMO or another type of health plan. Consider the type of doctor who best meets your needs, taking into account your age, health and personal preferences.
Most insurance companies have a “find a doctor” tool on their websites. This tool helps you locate a doctor in your network, which can lower your costs.
7 things to consider when choosing a primary care doctor
1. Determine what kind of doctor you need
Pediatricians treat children; family physicians treat people of all ages and internal medicine physicians care for adults.
2. Look into the doctor’s background
It’s important to pick a doctor whose education and interests fit your needs. At Scripps, you can click on Find a Doctor. There, you can read about different primary care providers. You can also check their education, training, languages and more.
3. Understand the doctor’s care philosophy
Different doctors have different interests and ways to treat patients. Some doctors use research-based methods that focus on one body part or condition. Others prefer a holistic approach that combines eastern and western ideas.
Many Scripps online doctor profiles include this type of information.
4. Make sure the doctor accepts your health insurance
Visit your provider’s website or call customer service for help. Insurance company websites often have a search tool. This tool helps you find out if a doctor, medical group or hospital is covered. You can also find a phone number to call with questions.
Scripps accepts many health plans.
5. Location matters
For many, it’s easier to have a doctor who’s close to home or work. In addition to location, make sure the office’s hours work with your schedule. Most Scripps primary care physicians have extended hours for convenience, including early morning, evening and Saturday appointments.
6. Make sure you can communicate with your care team
Virtual care, including video visits, provides convenience and easy access to get non-emergency medical help. You can use virtual care for follow-up appointments, prescription refills and minor health problems. Ask your primary care doctor if they offer this service and how easy it is to use.
Virtual care, also called telemedicine or telehealth, provides non-emergency health services through digital tools accessible via smartphones and computers.
7. Make sure you will be comfortable with your choice
Beyond the basics, pick a doctor who makes you feel at ease and with whom you are able to discuss your medical concerns openly. You may prefer a male or female doctor if that is important to you.
How to prepare for first doctor visit
Once you find the right provider, act quickly. It is important to start a new relationship right away.
Before the first appointment with your new doctor, contact the office to make sure they’ve received your records. You might also want to give them the names of your previous doctors so they can contact them, if needed. Ask which days and times are busiest at their office, to make scheduling easier.
On the day of your first appointment, arrive early to complete any paperwork. Bring any medications, vitamins or supplements you take. Be ready to share your family medical history and any other relevant information. This will help the doctor understand your health better.