the Price of Health Insurance from an HMO

When I was employed by a non-profit preschool, funded by the government, we were only required to pay a nominal amount for participation in an HMO. The amount was deducted from our paycheck and was only about forty dollars per month, which seemed like a bargain.

Almost everyone at the school where we participated in this HMO had problems receiving health services and with billing. Unfortunately I required surgery during this period, but there was no doctor in our HMO who specialized in this field of surgery. Luckily I was directed to a very good out-of-network surgeon, but that's where my problems started. On the eve of my surgery, after I had done all the paperwork and bloodwork and even started taking the nasty-tasting solution to empty my bowels, the billing department of the hospital handed me a bill for over ten thousand dollars which they stated had to be paid upfront. I left in tears, and spent the night on the phone with the HMO, doubled over with stomach cramps.

After finally getting them to approve payment for the surgery, I thought I was in the clear. Surgery went fine, but as soon as I got home I started receiving bills for every time they took blood or did any procedure, because neither I nor my dr. had gotten prior approval. These were standard lab procedures, nothing extraordinary. But I couldn't make the HMO understand that I had been unconscious when some of these procedures were done, so how could I have asked for approval. And my out-of-network dr. either wouldn't or couldn't get any answers from the HMO.

After my surgery I wasn't allowed to continue seeing the surgeon fro post op care because he was out-of-network, so I was sent to a series of the HMO's network doctors, most of which dropped out of the HMO shortly thereafter, so I never received any continuity of care. Ultimately I left the job, in part because of the stress over this and it's effect on my health. In the end, it was no bargain.

I would research any HMO and check whether they get a good consumer-approval rating. Also I would check whether they have enough doctors in your area so you have a choice, and make sure you know what the cost will be if you have to use an out-of-network doctor.