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HMO: Service Quality, Consumer Rights, And Filing Complaints
As an HMO participant, you are entitled to a certain level of care that should be reflected in the professionalism of the medical field. This entitlement is spelled out for you in the HMO contract and covers the various services and rights that you have and can expect. If you feel that you are not getting that quality of service, then there are ways that you can help to bring about the necessary changes. Here are some things that you can do about it.
Know Your Policy's Provisions
In order to be able to know what kind of service you can expect, you must know the policy and what it says. False expectations from a lack of understanding the policy will only result in confusion - and frustration. By knowing what it says, you will then know immediately if what you are receiving the quality of services that is to be expected or not.
Find A Doctor Who Knows How To Use The System
There are a number of doctors that you may designate to be your primary care physician. If you feel that your own doctor is not providing you with quality service, or answers, then you are free to change doctors - but there is a procedure to follow and it can take over a month to be able to see a new doctor.
Keep Records
If you feel that there may be some kind of problem, or that you are not getting the referrals or service that you think you want, or need, then it is a good idea to keep records. Talk to your doctor about it first - remember that he is the designated "gatekeeper" and must see a real reason for it before he will give you that referral. Any records, though, needs to include the date, person you talked to, the results you obtained, and what was discussed.
Be Strong And Make Demands
If, at first, talking is not getting you anywhere, then you need to be firm and let your wishes be known - and why. There are, within the member's manual, ways to go about appealing the decision of your doctor - if need be. It is best, however, to work with your doctor as long as possible. If you stay on friendly enough terms, your doctor may fight for you and help you to get the desired changes. Remember that he, too, must operate within the confines of the same system, so, a little patience will encourage him to work with you - not against you.
Quality Of Service Complaints
When you feel that you have not received a good level of service, then you can make complaints about it. The procedure is to talk to your doctor first. If you feel that satisfactory results were not obtained, look in your HMO member's handbook and find out how to contact your member services department. And then, if things still are not satisfactory, you may ultimately get in touch with the National Association of Insurance Commissioners. Other information about the process can be found online.
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Free Health Insurance Quotes
By comparing health plans with other rates, you should be able to find the right plan. You can get your free health insurance quotes at the following sites:
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