HMOs offer different types of coverage: staff, group, and network models. Each has advantages and disadvantages, with the network model being the most common but requiring specific procedures. Staff and group models limit choice but have simpler paperwork.
Health Maintenance Organizations (HMOs) are one of the most common types of insurance coverage available. There are three basic types of HMO models known as the staff model, group model and network model. These types are not based on the exact coverage provided, but rather the environment in which the care takes place.
In the HMO staff coverage model, doctors and nurses are employed directly by the HMO. There is one location that everyone covered by the plan must go to in order 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 slightly less structured type of HMO coverage. Group practices are contracted out by the HMO to provide cover for their clients. Staff are not employed by the HMO, although the group may be initiated by the HMO. Staff are able to treat patients with or without HMO coverage.
The most common type of HMO coverage is a network model. In this model, the HMO contracts with independent doctors, or groups of doctors, in order to receive special rates for their clients. As with the group model, staff can also deal with non-HMO customers.
When choosing HMO coverage, it’s important to know what type 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 staff or team models. In the staffing model, and some team models, doctors have more flexibility and generally have more resources at their disposal since everything is managed internally. The network model requires very specific procedures to be followed to obtain specialist examinations and appointments, a process which can require considerable legwork on the part of both the doctor and the 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 cannot choose a doctor who is closest to her position, or who likes her best, but must remain within the particular group. It can sometimes be difficult to get a second opinion, particularly in the staffing model, as doctors all work together. There are also often long waiting times for appointments.
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