History Plans HMO

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Introduction:

Plans Health Maintenance Organization – HMO plans for short – is a type managed care program. The idea behind managed care programs is that maintaining good health is achieved by preventing disease and providing quality care. By maintaining good health, it is believed that increasing health care costs will be controlled.

When first introduced HMO plans, members pay, a fixed monthly premium in exchange for a prepaid health care network of contracted providers. The contracted network of providers including hospitals, clinics and health care providers that have signed the contract with the HMO. In this sense, HMOs are the most restrictive type of managed care plans because they limit the procedures, providers and benefits by requiring that members use these providers and anyone else

History :.

HMOs were intended to take health care in a new direction. They were designed by the government to do away with individual health insurance plans and make affordable health insurance available to everyone. At the time employers are buying individual health insurance plans for their employees ~ costly expense that many are starting to give way.

The Health Maintenance Organization (HMO) in the Act approved by President Nixon in 1973. The managed health care plans subsidized by the government and began the new HMO-type systems to grow, usually organized by businesses and community groups eager to make health care available to their employees and members on the costs they could afford better. The subsidy covers created by the insurance companies to attract these businesses to buy these low-cost health plans for their employees new discount rather than individual health plans expensive.

Feel the power of the government behind them and the wild desire of employers to register their employees in the new HMO plans, insurance companies began to put pressure on doctors to join HMOs. Doctors were told that if they did not join, the insurance company to find doctors who would join and would take all their patients effectively away. Therefore, doctors ended up joining HMOs so they would not lose their patients and subsequently exercised overall.

As time went on, the insurance companies add more and more rules every time the doctor’s contract is renewed. The popularity of the Plans HMO means that most of their patients HMO plans so that they accept the new conditions. new terms include seeing more patients, more stringent confidentiality agreements, and more services that require pre-approval.

Until the 1980s, most of the members agreed that the HMO health plan is great. However, by the end of that decade, faces a number of claims denied mounting, members began to sour on the HMO plans.

What led to the increase of claims denied? It was not due to the claims themselves; was a result of bad investments by the insurance companies.

During the real estate boom, the insurance companies thought it would be a good idea to invest in a real estate deal. Unfortunately, when the savings and loans industry crash along with values ​​of real estate, insurance companies began to lose money. This led to their losses coming up short to pay their members’ claims HMO.

Thus began the practice to deny allegations of Plan HMO members. The insurance companies deny claims on the grounds that they are too expensive or unnecessary medical. At that time, members and their doctors are fighting these denials and because the insurance company is in the process claiming denial off so well, they have continued to do so as part of their operating procedure.

However, a new concept has emerged in recent year ~ law HMO.

now lawyers and law firms dedicated to bringing cases against HMOs. These allegations include wrongful death, bad faith and medical malpractice. This means that the HMO will be prosecuted when a person dies as a result of the HMO denied coverage for necessary medical treatment; damages for the denial of legitimate claims; and for medical malpractice on behalf of one of his doctors.

In addition, individual states are tightening up their laws governing Plans HMO .

In future articles we will discuss how to work HMO, HMO type of plans, cost plans and future plans.