HMO vs. PPO Doctors

May 26, 2007

  1. salpro22
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    salpro22 Guru

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    Are HMO doctors prohibited from working outside of their HMO plan.

    I vaguely reading somewhere saying that PPO doctors can negotiate with any insurance carrier/network they want, but once an HMO doctor is with a carrier (i.e., BCBS, KP, etc.) they cannot have contracts with other networks and carriers. Thanks.
     
    salpro22, May 26, 2007
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  2. GreenSky
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    GreenSky Guru

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    Typically a KP doc only works as an employee for Kaiser. Most other plans use independent medical groups who then contract with independent doctors.

    My doctor belongs to about 6-7 HMO plans and 3 medical groups.
     
    GreenSky, May 26, 2007
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  3. somarco
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    somarco GA Medicare Expert

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    Many, but not all, HMO's have staff PCP's. Specialists are usually in private practice and contract with HMO's as well as multiple PPO's
     
    somarco, May 26, 2007
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  4. Cenla Agent
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    Cenla Agent Guru

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    I am only familiar with Medicare Advantage HMO's and I don't think any HMO at all is currently offered in my small metro area. I believe with the Medicare plans the providers are independent contractors.
     
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