Health Maintenance Organizations (HMO) are one of the most common types of insurance coverage available. There are three basic types of HMO models known as the staff model, the group model, and the network model. These types are not based on exact coverage provided, but rather on the setting in which care takes place.
In the staff model of HMO coverage, the doctors and nurses are directly employed by the HMO. There is one location that all who are covered under the plan must go to receive coverage. The choice of doctors available is limited to those within that particular building. The staff does not treat any patients who are not covered by that particular HMO plan.
The group model is a bit less structured type of HMO coverage. Group practices are contracted by the HMO to give coverage to their clients. The staff is not employed by the HMO, although the group can be started by the HMO. The staff is able to treat patients with or without the HMO coverage.
The most common type of HMO coverage is a network model. In this model, the HMO contracts with independent physicians, or groups of physicians, in order to receive special rates for their clients. As with the group model, the staff can treat non-HMO clients as well.
When choosing HMO coverage, it is important to know what kind of model the plan follows. Each type of coverage has advantages and disadvantages that should be considered. The network model is by far the most common, but has some disadvantages compared to the staff or group models. In the staff model, and some group models, doctors have more flexibility, and generally have more resources at their disposal since everything is handled in-house. The network model requires that very particular procedures be followed in order to get tests and specialist appointments, a process that can require significant legwork on the part of both physician and patient.
The staff and group models are not without complications. While paperwork and procedures tend to be simpler, patients are limited when it comes to choice. A patient can not choose a doctor who is closest to their location, or who they like the best, but must remain within the particular group. Second opinions, particularly in the staff model, can sometimes be difficult to obtain since the doctors all work together. There are often extended wait times for appointments as well.
