This article was last updated June 25, 2020.
"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?
An HMO network gives you access to doctors and hospitals in a specific area and only covers out-of-network care in emergencies. You might also hear an HMO network referred to as a state-based network. 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
HMO network plans don't have many providers, so I won't be able to go to my local doctor.
If you have a state-based HMO 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 97 percent of doctors. Plus, some providers in the counties that border Iowa are considered in-network, too.1
Wellmark's state-based HMO network does not include the Wellmark ValueSM Health Plan HMO Network.
HMO network plans don't cover any chiropractor visits.
In-network chiropractors are covered on Wellmark's HMO plans, and almost 400 chiropractors are in the Wellmark's state-based HMO network. To find one in your area, log in to myWellmark Opens New Window.
I need a referral from my personal doctor, also known as a primary care provider (PCP), any time I want to see a specialist.
HMO network plans may not always require a referral. You may be able to go to any in-network provider — including specialists and chiropractors — without a PCP referral and without paying extra. That means an HMO network plan can give you the freedom to go to any in-network provider directly. Just be sure to log in to myWellmark to check your benefits before receiving services.
HMO network plans 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. Nationwide, more than 96 percent of hospitals and 95 percent of doctors and specialists are considered participating.2 Log in to myWellmark Opens New Window to find a participating hospital in your area.
If you're feeling a little under the weather while traveling, check out the Doctor On Demand 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.
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.
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 Blue Cross and Blue Shield network numbers as of July 2019.
2 Consortium Network Compare Findings as of September 2019.