Health Maintenance Organizations (HMOs)

According to the resource posted on Michigan.gov, Department of Licensing and Regualtory Affairs:

Health Maintenance Organizations (HMOs) provide preventive care and other services that are basic to good health. It is a health care system that joins together the financing and delivery of health care services to covered individuals by arrangement with selected providers who furnish a broad set of health care services

The HMO resource includes the following topics:

• The HMO Difference, Advantages & Disadvantages
• Primary Care Physician
• HMO Provider Network, HMO Service Area, HMO Eligibility
• Individuals Open Enrollment FOR HMOs
• HMO Coverage for Pre-Existing Conditions
• HMO Underwriting, Basic Health Services and Mandatory Coverage
• Services Not Covered By HMOs
• Emergency Services From an HMO
• HMO Prescription Drug Coverage
• HMO Deductibles, Copayments And Coinsurance
• HMO Claim Handling
• HMO Coverage for Family Members and Coordination of Benefits
• HMO Complaints and Grievances
• Medicaid HMO Clean Claims

To view the full resource, please go to the following link: Health Maintenance Organizations (HMOs)

For additional billing and coding resources, please click the following link: Medical Reimbursement, Inc. Resources