HMO's.....how can I?

[TonyC]

How can i sell against an HMO?

I am located in S.Fla. and we have an "Vista" which is a major HMO down here with a large network of doctors.

When selling against an HMO...What are some of the selling features that a Major Med has...that HMO's don't have?


thanks in advance

 

[Expat]

How can i sell against an HMO?

I am located in S.Fla. and we have an "Vista" which is a major HMO down here with a large network of doctors.

When selling against an HMO...What are some of the selling features that a Major Med has...that HMO's don't have?


thanks in advance

Freedom of choice when it comes to doctors/specialists.

 

[LGilmore]

gatekeepers. Some folks love em and others hate em. an hmo plan usually entails "asking permission" for medical care, other plans don't.

 

[TonyC]

thanks guys....i also heard you may have to travel for a specialist....

anyone else....?

 

[Crabcake Johnny]

Just the referral needed to see a specialist is a pain in the ass.

Personal story. I have mild case of acne rosacea - reddening of the face. No real biggie.

Years ago I was in a HMO through work when the reddening occurred - didn't know what it was so I called my primary care doctor. Got in a few days.

She calls it something - forget - after literally looking at my face for a few seconds - wrote me out a prescription for Metrogel - which is a steroid and kicked me out of the office. I literally was in there for no longer then a few minutes.

Put the gel on my face and it was like a blow torch hit it. It turned bright red and was painful. Could I go see a dermatologist? No - not without a referral.

So BACK to my primary care doctor - which took a week this time (and my face was in horrible shape the entire week) she admits that it could be "several things" - fights me on the referrals - wants me to try another med.

I refused. Obviously pissed off she writes me out a referral slip. I finally end up at the dermatologist's office who spends about 20 minutes with me and determines that it's acne rosacea.

Treatment? Mild soap without any perfumes, lay back on any alcohol and certain foods and it'll clear up. Absolutely do not take any meds with a steroid. It's incurable so there's no reason to be on meds.

When you seen a HMO doctor you a part of the cattle. They receive money whether they see you or not - so it's race to kick your ass out of the office as quickly as possible. If you don't come back they're ahead of the game financially.

PPO doctors ONLY make money when they see you. Also, for obvious reasons specialists know what they're doing. Primary care doctors? You might as well surf WebMD - Better information. Better health. and don't waste your time even going.

 

[somarco]

Regional HMO's can be very good or very bad. They are spotty in GA and mostly marginal players.

HMO's typically offer very good value but the rules are different here (to coin a phrase). I never cared much for them but have come to appreciate having the HMO option.

KP is our local HMO offering group and individual major med. There are others offering group only, but KP is the only one offering individual.

I have quite a few clients with KP and wish I had more. Almost like group clients, they never leave. I have fewer complaints from my KP clients than any other carrier.

When you have HMO coverage, moving out of the service area is almost impossible unless you have someone like KP and move to another area serviced by KP.

There's good & bad.

 

[Crabcake Johnny]

In MD KP offers HMO plans but with no referrals needed. Very nice.

 

[J.R.]

Regional HMO's can be very good or very bad. They are spotty in GA and mostly marginal players.

HMO's typically offer very good value but the rules are different here (to coin a phrase). I never cared much for them but have come to appreciate having the HMO option.

KP is our local HMO offering group and individual major med. There are others offering group only, but KP is the only one offering individual.

I have quite a few clients with KP and wish I had more. Almost like group clients, they never leave. I have fewer complaints from my KP clients than any other carrier.

When you have HMO coverage, moving out of the service area is almost impossible unless you have someone like KP and move to another area serviced by KP.

There's good & bad.

Don't you own a KP HMO plan? I could've sworn you said that sometime ago.

 

[somarco]

We had KP then switched to UHC with a high deductible. The KP HSA is mediocre.

 

[Sam]

Vista is a decent company and they have some nice products. They have a really attractive deductible plan where anything done outpatient is in front of the dedutible, only hospital services are behind the deductible, but it is priced to compete with regular high ded. plans with most services after the deductible.

Most of their plans also do not require referrals. Since they were bought by Coventry, there isn't even a ratings argument against them like there would be with Avmed.

If they are on an open access product and they are happy with the service, then it will be really hard to compete with them. Maybe ask for an AOR instead.