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6 HMO myths debunked article

6 HMO myths debunked

Sort fact from fiction

"I won't be able to get the kind of care I need."

"I can't make an appointment with the doctor I want to see."

"I won't have any out-of-state coverage."

Are these types of statements about a health maintenance organization (HMO) network swirling in your head? Are they making the process of choosing a health plan or understanding your current benefits even more confusing? Are they even true?

It's no secret that HMO networks of the past had a bad reputation. And, with so many misconceptions about this type of network, it's no wonder there's confusion. So, let's set the record straight.

Top-six HMO myths

  1. Myth:

    HMOs don't have many providers, so I won't have access to my local doctor.


    If you have a state-based HMO network plan and need care in Iowa, there's a good chance you're covered. The network spans all of Iowa's 99 counties, including 100 percent of hospitals in the state and 96 percent of physicians. Plus, some providers in the counties that border Iowa are considered in-network, too.1

    HMO networks come in all shapes and sizes. One of the best ways to keep your health care costs down is to choose an in-network provider by logging in and using the myWellmark® Care Finder.

    Wellmark's state-based HMO network does not include Wellmark ValueSM Health Plan HMO Network or Wellmark SynergySM HMO Network.

  2. Myth:

    HMOs don't cover any chiropractors.


    Almost 400 chiropractors are part of Wellmark's state-based HMO network. To find one in your area, log in to myWellmark and use the myWellmark Care Finder.

  3. Myth:

    I need a referral from my primary care provider (PCP) to go to a specialist.


    You can go to any in-network provider — including specialists and chiropractors — without a PCP referral. This means you have the freedom to go to any in-network provider directly.

  4. Myth:

    HMOs are too risky because I won't have emergency coverage if I'm not in Iowa.


    If you're traveling out-of-state, you have coverage for emergency care. Just use the Find a Doctor tool to find a participating hospital. Nationwide, more than 96 percent of hospitals and 93 percent of doctors and specialists are considered participating.2

    If you're feeling a little under the weather while traveling, check out the Doctor On DemandTM External Site app, where you can see and talk with a board-certified doctor. Your virtual doctor can treat most common medical conditions, and even prescribe medication if needed. A virtual visit through Doctor On Demand is an affordable option covered by some Wellmark plans. You can also purchase a virtual visit without using your insurance information.

  5. Myth:

    HMOs never allow access to out-of-network providers and services.


    If the care you need is not available within the HMO network, you may be approved for out-of-network care. Talk to your in-network provider about making a request for out-of-network care on your behalf before receiving out-of-network care.

  6. Myth:

    HMOs don't work for families with college students and snowbirds.


    Dependent children attending college, long-term travelers, and families living apart may be covered through guest membership. Guest membership provides benefits for eligible people living out of state for at least 90 days, but you have to sign up before leaving.

Need more explanation about health insurance and how it works? Take 10 minutes to understand your coverage.

1 Wellmark Network Administration, 2018

2Blue Cross Blue Shield Association, 2018