Life Threatening Secrets Of HMO And Insurance Plans

QUESTIONS FOR EMPLOYERS AND PATIENTS TO ASK
BEFORE THEY JOIN AN HMO OR INSURANCE PLAN

  1. Do primary care gate keeper doctors get more money if they deny referrals to specialists, testing centers or hospitals? Please describe the existing incentives.
  2. What percentage of the monthly HMO premium actually goes to the doctors?
  3. What percentage of the monthly HMO premium actually goes to the hospital?
  4. What percentage of your primary care doctor's practice is HMO?
  5. What percentage of your primary care doctor's income comes from the specific HMO?
  6. How much money per month is actually received by your primary care doctor from your premium?
  7. Does the HMO contract with the doctor allow the HMO to terminate the contract if the HMO believes the doctor is overutilizing services?
  8. Does your insurance plan have an "experimental/investigative" exclusion? Do you understand it? Does your company understand it? Can they explain it?
  9. What are the most frequently requested procedures presently being denied by your HMO on the basis of "experimental/investigative" or "not medically necessary" exclusions?
  10. Do the primary care doctors receive bonuses at the end of the year from the HMO if they limit referrals to specialists or hospitals?

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