Question

What is the relationship between the insurer and the provider in an HMO?

Answer 1

HMOs provide medical treatment on a prepaid basis, wherein the HMO members pay a fixed monthly fee, regardless of how much medical care is required in a given month. It is an organization which arranges for the healthcare benefits of the beneficiary by acts as an intermediary between the insurer and the service providers. Although HMOs offer lower costs, however a more restrictive provider network and insurer have to coordinate the medical care through a primary care physician. Thus it is vital that HMOs and insurers are needed to maintain a provider network that is sufficient to meet the health requirements of insurers and provide an appropriate choice