What are health care maintenance organizations (HMO)?

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Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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UPDATED: Feb 24, 2015

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Private health service plans which promise to provide care, not merely pay for it, are often referred to as Health Maintenance Organizations or HMO’s. Some are “closed panel plans” and operate out of a central facility, with all the health care providers employed by the HMO. When you go to the facility you may see the doctor on duty, or your “assigned physician”.

Other HMOs are more loosely affiliated models, sometimes called Individual Practice Associations (IPA) or open panel plans, where the participating health care providers operate from their own offices. This has been called an HMO without walls, and is similar to a PPO. The difference between a PPO and an IPA is in how the physicians are compensated. With a PPO, you might have to contribute more to the payment for each visit. An IPA means that the network is directly compensating the physician, and there is no doctor’s “bill” to be allocated between you and the insurer.

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