QUESTIONS FOR EMPLOYERS AND PATIENTS TO ASK
BEFORE THEY JOIN AN HMO OR INSURANCE PLAN
- Do primary care gate keeper doctors get more money if they deny referrals to specialists, testing centers or hospitals? Please describe the existing incentives.
- What percentage of the monthly HMO premium actually goes to the doctors?
- What percentage of the monthly HMO premium actually goes to the hospital?
- What percentage of your primary care doctor's practice is HMO?
- What percentage of your primary care doctor's income comes from the specific HMO?
- How much money per month is actually received by your primary care doctor from your premium?
- Does the HMO contract with the doctor allow the HMO to terminate the contract if the HMO believes the doctor is overutilizing services?
- Does your insurance plan have an "experimental/investigative" exclusion? Do you understand it? Does your company understand it? Can they explain it?
- What are the most frequently requested procedures presently being denied by your HMO on the basis of "experimental/investigative" or "not medically necessary" exclusions?
- Do the primary care doctors receive bonuses at the end of the year from the HMO if they limit referrals to specialists or hospitals?
Hiepler & Hiepler, Serving All of California
Representing Victims of Insurance Companies and
Those Who Have Been Seriously Injured in Accidents