What is an HMO

HMO stands for Health Maintenance Organization, which is a provider of healthcare based on the contacts of insurance in United States of America. HMO has collaboration with various different hospitals, medical institutions, healthcare facilities as well as with doctors. There are basically two types of HMOs, open access HMO and other is closed access HMO. The basic difference between open and closed access HMO is that, open access does not require a gatekeeper doctor, who refers patients to specialist doctors, at times; when emergency strikes him patients. Closed access HMO needs a referring doctor who refers a patient to a specialist doctor at times of emergency, keeping in mind the guideline of HMO.

Different types of HMO models

One can understand about HMO, if one gets to know the working of HMO. There is no fixed way in which these HMOs work, and hence the structure of the organization may be completely different from one another. But nevertheless there are five major ways in which their model may be linked. The five popular models of HMO are as follows:

 

  • Staff Model
  • Group Model
  • Captive Group Model
  • Independent Group Model
  • Network Model

All these models are either used as they are, or they can be in a blended form, in a HMO. All these models are basically based on how the patients are treated, and the procedure of his treatment in accordance with the staff management. Understanding these models will help you solve your ‘What is HMO?’ question.

Online reference

In order to understand all about HMO, you must look for information in various websites over the internet and get a clear picture of HMO and its working. There are many organizations, which you can find these days, some of them are:

 

  • WellPoint
  • UnitedHealth Group
  • Health Net
  • CIGNA
  • Aetna

 

These insurance companies are pioneers of this industry and they are known to provide best of services in this field of healthcare. If you want to know more about HMO, or these companies you can refer to online websites, do a bit of research on the subject, and get a clear picture of Health Maintenance Organizations.

License of an HMO

Both Federal as well as State regulates HMO. The State certifies these organizations and they provide them with COA certificate, which also serves as the license for these HMOs. HMO doesn’t get licensed under by insurance licenses, also federal regulators issue mandated in association with the state to these HMOs. HMOs have lots of restrictions, and hence one should know all the details, how these organizations work, and what are its rules and regulations, about treatment of patients of a particular type of disease.

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