Healthcare plans come in about three general types: (1) those where you can see any doctor you want (often called fee-for-service); (2) those where you can see any doctor you want, but the insurance company will pay less if the doctor you pick is “out-of-network” (not in their plan, often called a PPO); and (3) those where they won’t pay at all for your care unless you use in-network doctors (often called an HMO).
If you’re able to choose your healthcare program, pick the first or second option whenever possible.
And only choose the third option if you absolutely have no other way to get healthcare.
Why? Because your best option at getting good medical care is to be able to see a specialist or other doctor who has been recommended to you by a trusted friend or other doctor. And if one of those recommended doctors i not on the HMO list, then you may just be picking a doctor in total darkness.
Your HMO only checks to see if the doctor has the right “credentials” and “specialty certification.” Unfortunately, those alone don’t guarantee that you get a good doctor.
“The various accreditation and licensure programs for health care organizations and providers have been promoted as ‘Good Housekeeping Seals of Approval,’ yet they fail to provide adequate assurance of a safe environment. Reducing medical errors and improving patient safety are not an explicit focus of these process.”1
Studies, Footnotes and Resources:
- Institute of Medicine. To Err is Human: Building a Safer Health System. Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, eds. Washington, D.C.: National Academy Press, 2000, p. 43.