What follows are notes to myself based on 30+ years of observing the managed care market. Notes are factual but should not be misconstrued as applying to ALL plans EVERY time.
HMO HAS LOWER FIXED COSTS
LOWER PREMIUM, COPY, MOOP
MORE ATTRACTIVE EXTRA BENEFITS (DENTAL)
NO REFERRAL TRICK
INSURED GOES OON, CLAIM DENIED, MORE COST SHIFTING
ACCESS TO FEWER SPECIALISTS
ACCESS TO FEWER HOSPITALS
FEWER FORMULARY DRUGS
GREATER HMO CONTROL OVER CLAIMS
MORE PRIOR AUTHORIZATIONS, DELAYS, DENIALS
HMO LOOKS MORE ATTRACTIVE TO CONSUMER
AGENTS WHO DON’T UNDERSTAND THE HMO PLAN WILL HAVE MORE ATTRITION
AGENTS LOOKING AT COMP, IGNORING IMPACT ON CONSUMER, WILL HAVE MORE ATTRITION
AGENTS SELLING HMO ON PRICE, BENEFITS IGNORING HMO LIMITATIONS, WILL HAVE MORE ATTRITION
YMMV
All caps and shorthand are for my note taking benefit and should not be seen as shouting. I find all caps easier to read, especially when summarizing.
HMO HAS LOWER FIXED COSTS
LOWER PREMIUM, COPY, MOOP
MORE ATTRACTIVE EXTRA BENEFITS (DENTAL)
NO REFERRAL TRICK
INSURED GOES OON, CLAIM DENIED, MORE COST SHIFTING
ACCESS TO FEWER SPECIALISTS
ACCESS TO FEWER HOSPITALS
FEWER FORMULARY DRUGS
GREATER HMO CONTROL OVER CLAIMS
MORE PRIOR AUTHORIZATIONS, DELAYS, DENIALS
HMO LOOKS MORE ATTRACTIVE TO CONSUMER
AGENTS WHO DON’T UNDERSTAND THE HMO PLAN WILL HAVE MORE ATTRITION
AGENTS LOOKING AT COMP, IGNORING IMPACT ON CONSUMER, WILL HAVE MORE ATTRITION
AGENTS SELLING HMO ON PRICE, BENEFITS IGNORING HMO LIMITATIONS, WILL HAVE MORE ATTRITION
YMMV
All caps and shorthand are for my note taking benefit and should not be seen as shouting. I find all caps easier to read, especially when summarizing.
