• Aetna
• Assurant
• Blue Cross and Blue Shield

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• GoldenRule
• Humana

• Supplemental Medigap Insurance
• Medicare Advantage Insurance
• Blue Cross and Blue Shield

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• Humana
• SecureHorizons by UnitedHealthcare
• Universal American
• WellCare

Louisiana HMO Health Insurance Policies

What are the types of Insurance?

Health Maintenance Organizations (HMO)

Health Maintenance Organizations (HMOs) are prepaid health plans. As an HMO member, you pay a monthly premium. In exchange, the HMO provides comprehensive care for you and your family, including doctors' visits, hospital stays, emergency care, surgery, lab tests, x-rays and therapy.

The HMO arranges for this care either directly in its own group practice and/or through doctors and other health care professionals under contract with the HMO. Usually, your choices of doctors and hospitals are limited to those that have agreements with the HMO to provide care. However, exceptions are made in emergencies or when the care is medically necessary.

There may be a small copayment for each medical service, such as $5 for a doctor's visit, $25 for care by a specialist or $200 for hospital emergency room treatment. Your total medical costs will likely be lower and more predictable in an HMO than with fee-for-service insurance.

Because HMO physicians receive a fixed fee for your covered medical care, it is in their interest to make sure you get basic health care for problems before they become serious. HMOs typically provide preventative care, such as office visits, immunizations, well-baby checkups, mammograms and physicals. The range of covered services varies in HMOs, so it is important to compare available plans. Some services, such as outpatient mental health care, often are provided only on a limited basis.

Many people like HMOs because they do not require claim forms for office visits or hospital stays. Instead, members present a card at the doctor's office or hospital. However, in an HMO you may have to wait longer for an appointment than you would with a fee-for-service plan.

In some HMOs, doctors are salaried. Salaried doctors have offices in an HMO facility at one or more locations in your community as part of a prepaid group practice. In others, independent groups of doctors contract with the HMO to take care of patients. These are called individual practice associations (IPAs), and they are made up of private physicians in private offices who agree to care for HMO members. You select a doctor from a list of participating physicians that make up the IPA network. If you are thinking of switching into an IPA-type HMO, ask your doctor if he or she participates in the plan.

In almost all HMOs, you either are assigned or you choose one doctor to serve as your primary care doctor. This doctor monitors your health and provides most of your medical care, referring you to specialists and other health care professionals as needed. You usually cannot see a specialist without a referral from your primary care doctor, who is expected to manage the care you receive. This is one way that HMOs can limit your choices; however, exceptions may be allowed for some specialists.

Before choosing an HMO, it is a good idea to talk to people who are enrolled in one. Ask them how they like the services and care given.

Questions to Ask About an HMO...

• Are there many doctors to choose from? Do you select them from a list of contract physicians or from the available staff of a group practice?
• Which doctors are accepting new patients?
• Does the HMO offer the services you want? What preventative services are provided? Are there limits on medical tests, surgery, mental health care, home care or other support offered? What if you need a special service not provided by the HMO?
• What is the service area of the HMO? Where are the facilities that serve HMO members located in your community? How convenient to your home and workplace are the doctors, hospitals and emergency care centers that make up the HMO network?
• What happens if you or members of your family are out of town and need medical treatment?
• What will the HMO plan cost? What is the yearly total for monthly fees? In addition, are there copayments for office visits, emergency care, prescribed drugs or other services?