All About HMO Insurance Plans: We Separate Myth From Fact

Health care is confusing. And that’s coming from someone who works for HAP. The medical jargon. The acronyms. It’s a lot to process. I get it. That’s why we work hard every day to present you with member resources that make sense. Why? Because we’re all in the same boat. If it doesn’t make sense to us, how can we expect it to make sense to our members?

Speaking of acronyms, I want to talk about one that causes a lot of confusion, especially around open enrollment time: HMO.

First things first, what is HMO insurance? Technically, HMO stands for Health Maintenance Organization, but to me that’s just as confusing as the acronym. What’s a “health maintenance organization” anyway?

Things you need to know about HMOs: An HMO is a type of health plan where you receive care within a specific network of doctors and hospitals. HMO insurance plans also require you to pick a primary care physician, also known as a PCP, who is part of that network. Think of your PCP as your point person. He or she provides all your basic health care services. You also can see a specialist at any time as long as they are in your network.

Some people will tell you that those few requirements are limiting. And that’s where the myths start. I thought it’d be helpful to share what I’ve learned during my time at HAP to clear up any confusion about HMOs, which I think are affordable, robust options for people shopping for care. In fact, my plan is an HMO.

Myth: If I choose an HMO insurance plan, I’ll have a limited choice of network options.

Fact: This may have been true back when HMOs were first offered, but it’s not the case today. The HAP HMO service area spans 18 counties across east central and southeast Michigan. It also includes a vast network of leading doctors and hospitals. In fact, because our network is so large, there’s a pretty good chance your doctor is a HAP doctor; mine was. You can check our provider search tool to find out.

Myth: Once I pick a PCP, I’m stuck with him or her.

Fact: Unlike some other HMO insurance plans, HAP lets you change your PCP whenever you want. You can do this online by logging into hap.org or by calling our automated services line 24/7 at (877) 427-3678.

Myth: I’ll need to visit my PCP first or get a referral every time I want to see a specialist.

Fact: With HAP, you have the freedom to see your HAP dermatologist or allergist without referrals. In fact, in our provider network, many specialty office visits don’t require referrals from your PCP. Here are some of those specialties:

• Dermatology
• Cardiology
• Podiatry
• Allergy
• Standard X-ray
• OB-GYN
• Routine labs

Myth: The referral process is a hassle.

Fact: If you do need a preauthorization (often called a “referral”) before you get a service, our paperless referral system makes the process hassle-free. Your PCP does all the work for you. You simply show up at your appointment and your referral will have already arrived.

If you want to check whether your paperwork has been completed, log in at hap.org, then click Referral Authorization Records.

Myth: If my PCP is booked up while I’m sick, I won’t be able to get in or see someone else.

Fact: Your PCP is your point person, but he or she is not the be-all and end-all. You can get the care you need when you need it. As long as you stay within the network outlined in your plan, and the provider accepts HAP, you’re covered.

Instead of heading to urgent care the next time you need to see someone quickly, when it’s not an emergency, try one of Henry Ford’s same-day clinics. You can skip the waiting room by reserving your spot online. Once your reservation is complete, you’ll get a text to remind you of your appointment time so you know when to leave your home or workplace. And, as an added bonus, it’s usually the same copay as a regular office visit rather than your urgent care copay.

Myth: I won’t be covered when I travel.

Fact: HAP plans provide worldwide emergency and urgent care coverage, as well as same or next-day urgent care appointments. On top of that, if you need emergency travel assistance when you’re more than 100 miles away from home or in another country, HAP’s partner Assist America is here to help. Some of their services include:

• Help with lost prescriptions, eyeglasses replacement or luggage
• Document translation help
• Emergency medical evacuation
• Hospital admission guarantee

These are just a few of the HMO myths floating around out there. Our goal is to make access to care and resources as easy as possible. If you are a member and have questions, call our team of personal service coordinators at (866) 766-4712 or 711 for TTY services Monday through Friday from 8 a.m. to 4:30 p.m. You also can log in at hap.org and send us a message.

If you’re not a HAP member and would like more information about becoming one, visit us at chooseHAP.org.