4 HMO Traps to Watch Out for

Dealing with an HMO can be an exercise in patience sometimes. You don't understand the rules and then when you do, they change them. It really takes a lot of work to stay on top of your HMO and sometimes, you will be hit with unexpected expenses. While HMO's can be a good thing, they do have certain traps that they like to use on customers. Watch out for these things when dealing with your HMO.

1. Out-of-Network

The biggest mistake you can make in regards to an HMO is to go to a medical facility that is out-of-network. Your HMO has contracted with a very specific network of doctors and medical facilities. They have set pricing on everything from a doctor visit to an apendectomy. If you want your costs to be controlled to some extent, it is vital that you visit one of these facilities. They have one price for in-network costs and another, much higher cost for out-of-network coverage. It will often be three or four times higher to go out-of-network. If you are not facing a life or death situation, it is in your best interest to find a medical facility that is in their network.

2. Preexisting Conditions

Another common trap that people fall into is with preexisting conditions. If you have a preexisting condition, do not even consider switching insurance companies. If at all possible, try and get the condition taken care of before you lose your current coverage. Otherwise, you will not be covered by it at all. If you start using an HMO, they will get a detailed history of your medical conditions. If you have been treated for something recently, they will know about. Therefore, don't even try to hide it from them. They will find out about it and refuse to pay for it. With preexisting conditions, you are on your own.

3. Waiting Periods

A common tactic that is common between all HMO's is a waiting period once you are accepted. After they tell you that you have coverage, there is a certain amount of time before it goes into effect. Ask them plainly when that date is. If you were to go in and have something done, they would not cover it or any of the resulting treatments. You need to hold off if at all possible until your effective date comes. Of course, if it is an emergency situation, you do not have a choice. However, if you've been living with it for a while, you can wait another few weeks until your policy is active.

4. Family Deductibles

Adding someone to your policy after the fact has confused many people in the past. For example, let's say that you have a $1000 deductible on your individual policy. Then you decide to add your spouse to the policy. Instead of using common sense and assuming that their deductible would also be $1000, now your family deductible is $2500. You were expecting $2000 worth of deductible but have a $2500 deductible. Make sure that you understand any changes to your policy up front.

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