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Guide to Choosing your Preferred HMO

Table of Contents

Introduction

Like buying any other important thing, it is important to do quality research before committing hard earned funds into any purchase. Just like acquiring sales expertise, it is very important to acquire buying expertise. There are exact questions that you should ask in your quest to choose the right HMO for your company. This write up is put together to enlighten you on the exact metrics you need to base your choice of HMO on so that you don’t fall victim to HMOs with poor service. 

 

Here are a few factors you should consider.

Is this HMO a responsive HMO?

According to the Cambridge Dictionary, to be Responsive means to be ‘quick to act’. 

 

The kind of service that the HMO industry provides is a unique one. The industry provides healthcare services and so, service failure can be life threatening.  The issue of responsiveness is therefore a very important one. Before choosing an HMO, you must ensure that they have a high level of responsiveness. You should put a test call through to the call center to see how proactive the HMO is in resolving issues.

What Current Clients are being covered by this HMO?

Unless you want your company to be a guinea pig or a lab rat for experimentation, then you may want to ensure that there are existing satisfied clients currently being covered by the HMO Company in consideration. You can easily do this by putting a call through to the HR Managers of the Clients they currently service and checking up with them to get real time reviews on the quality of the service they are receiving from the HMO in consideration.

 

Usually, information as regards the clients being managed by the HMO in question would be on the website. However, if it is not there, then you may want to go the extra mile of asking the HMO Company to send you the contact details of some of the Clients they manage so you can do your due diligence.

Are the processes of this HMO automated or manual?

You really need to check this. This is important because the volume of lives covered by HMO Companies is quite large. This means that they have to do so many things. They have to register every new enrollee onto their database. They have to generate approval codes for all health requests. They have to create a system of confirmation for the identity of all Enrollees who seek for health care services in the hospitals. They have to process claims of hospitals to ensure the absence of fraud; a process that may be a little cumbersome. They have to pay hospitals. Now, imagine the HMO Company having to carry out these processes for hundreds of thousands of enrollees. Of course, if their processes are not automated, service failure would almost become a norm. 

You therefore need to ensure that the HMO in question has the technological capacity to carry out processes like enrollment and healthcare processes automatically.

 

This may form part of the queries you may present to the Clients they currently manage when you interview with them.

What Preventive Healthcare measure does this HMO have in place?

The trend of the industry in recent times has been that of preventive rather than curative. Yes, the HMO is obligated to pay the hospital bills of enrollees in the event of need. However, the biggest priority for the HMO should be to ensure that their enrollees do not even have any cause to go to the hospital. In other words, the HMO company should be more concerned about keeping its enrollees in perfect health without the event of sicknesses.

 

There are a number of ways and strategies by which this is achieved currently in the industry. Through free screening services, health education monthly seminars, provision of discounted health products through partnerships with other companies, provision of access to spas and gyms etc, HMO Companies are now able to significantly reduce the rate of illnesses amongst their enrollees.

Coverage

Some people, in their quest to get an HMO Company to partner with, only consider the price/premium. This is not good enough. It is important that you also take a deep look at the benefit coverage. One of the benefits of getting Health Insurance for your staff members is that you get to enhance their productivity. Now, how do you achieve this when the majority of the things that bring about reduced productivity in staff members are not covered by the HMO plan that was purchased? The money expended on the HMO Cover then becomes a waste.

 

It is therefore important that you take your time to understudy the coverage of the HMO cover being considered for purchase. Click here to read on how to understudy an HMO benefit coverage. You may also want to consider speaking to a doctor to explain terms in the agreement with respect to the benefit coverage.

Provider Network

In the HMO Industry, the Hospitals that actually do the care provision are known as the Providers. 

 

It is important that you take a critical look at the Hospital Network of the HMO Company. You need to check their spread. Even if your company does not have a national spread, you still should ensure that you are coming on board with an HMO that has a national spread with respect to the hospital network. This is because your employee could, for one reason or the other, be within another geographical location and need to access care.

You also need to ensure that the Hospitals under the HMO’s provider network are standard Hospitals. You sure don’t want to be sending your employees to hospitals that would worsen the conditions of your staff members when they go to access care.

How much is the Premium?

Now to the most asked question. This is what most people are concerned majorly about when seeking to purchase an HMO plan. And yes, it should be a concern. After all, who wants to use all his wealth to take care of his health?

 

Having considered all the above, the cost of premium should also be considered and negotiated if need be.