Health Maintenance Organization


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An HMO is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities in the U.S. and acts as a liaison with health care providers on a prepaid basis.  HMOs often require members to select a primary care physician, a doctor who acts as a ‘gatekeeper’ to direct access to medical services.  Except in medical emergency situations, patients need a referral from the primary care physician in order to see a specialist or other doctor, and the gatekeeper cannot authorize that referral unless the HMO guidelines deem it necessary. With an HMO you will likely have coverage for a broader range of preventive healthcare services than you would through another type of plan, hence its name.  HMOs are typically less expensive in comparison to a PPO or EPO, but you will likely have no coverage for services rendered by out-of-network providers or for service rendered without a proper referral from your primary care physician.  

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