What is HMO?Don’t let the acronym scare you! HMO stands for Health Maintenance Organization. It’s a type of health plan that gives you access to certain doctors and hospitals, often called network or contracting doctors and hospitals (sometimes called “providers”). These health care professionals work together to provide you with a full range of covered health care services. It differs from a PPO (Preferred Provider Organization) in a few ways.
HMO Cost and Coverage:
If you look for care outside the network, other than in an emergency or with preauthorization from your HMO, your care typically will not be covered at all.
HMO Insurance Doctors and Care:
If you need special tests or need to see a specialist, your PCP will give you a referral to see another doctor. It’s always a good idea to search our Provider Finder to make sure the specialist is in your network. Remember, if the specialist isn’t in your network or if you haven’t received a referral from your PCP, the services won’t be covered.
Key Things to Remember about HMOs:
Help and ToolsIf you have more questions about your HMO, call the customer service number on the back of your member ID card. You can also sign up for Blue Access for MembersSM to keep track of your balances, claims status, benefits, coverage details and more. If you are not yet a member but are considering purchasing an HMO Insurance plan, check out our shopping guide and call our enrollment team with any questions at 800-531-4456.
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