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When Dealing with your HMO

Dealing with your HMO provider can be very stressful. The tips below will help make your interaction with your HMO provider as stress-free as possible.

  • Know the name of the HMO that provides your health coverage.
  • Know how to contact your HMO.
  • Know what type of coverage you or your employer have bought for you. This information will be in your evidence of coverage. Your HMO must cover what it said it will cover when you bought the insurance.
  • Take the time to read your plan's evidence of coverage. This document is usually mailed to you by your plan and it tells you what you are entitled to under the plan you bought. You can hold your plan to its word through this document!
  • Keep all the paper work your plan sends to you. Keep all of it in one place and be familiar with it. If there are things you do not understand, call the plan's customer service department (the number will be in the evidence of coverage and on the HMO patient membership card). If you get your health insurance through your employer, the personnel department may be able to answer some of your questions.
  • Become familiar with your plan's grievance process. A grievance is a formal way of filing a complaint with your plan if you are not satisfied. This process is required by law, and your evidence of coverage will include an explanation of what you have to do to file a grievance with the plan.
  • As a patient, you have Rights and Responsibilities. Know what they are. Know what you have to do, and what your HMO has to do in order for you to get the best health care possible.

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