I am saying that you will probably have problems seeing a a well-recommended doctor if he is not under the HMO network umbrella.įor more information, read this article. I’m not saying you don’t have choices of good doctors if you have a HMO. plus, you have to go to the family doctor first even befor the surgery talks. Don’t expect the insurance company to help out with out-of-network costs if you’re a HMO customer. They must choose specialists in their prescribed network, and no out-of-network coverage is generally available. HMO customers don’t have this kind of flexibility. If your surgeon accepts your health insurance, then your insurance company will cover a percentage of the costs–in-network and out. Of course, the surgeon has to accept your health insurance. So you choose another surgeon from the list of your HMO’s providers. Then you find out that there are other surgeons in the network that are highly recommended. The doctor tells you you can’t see Surgeon B because he’s not covered under your HMO plan. You suggest Surgeon B because Surgeon A is not well recommended. The most rigid of the network types is the HMO. Your family doctor refers you to Surgeon A. Just know that you will probably pay more for your visit if you see a specialist out of network.įor more information, read this article. The dermatologist doesn’t even have to be included in the insurance company’s network! You can call ahead and see if the doctor takes your PPO insurance. If you are suffering from Acne, then you can go see that dermatologist your friend recommended. Or, you can go straight to the specialist yourself without first speaking to your family doctor. You can take the primary care physician’s recommendation and get a referral. If you are a PPO subscriber, you will have this freedom. You can take the doctor’s recommendation, or you can choose between all of the surgeons in the PPO network that specialize in the particular procedure. Your primary care doctor tells you it is a minor procedure, and he recommends a good surgeon.
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