Help Desk FAQ

Healthcare/Medical

Health insurance

 

What are some available sources of help in evaluating an HMO?

In most states, the government agency responsible for regulating HMOs conducts annual or bi-annual reviews of the HMOs they regulate. Some version of these reports is usually made available to the public for use in evaluating HMOs. Contact the regulatory agency in your state that oversees HMOs. (In many states, this is the insurance department.)

The National Committee for Quality Assurance (NCQA) is a non-profit review organization that works with employers, doctors, medical institutions and HMOs on standards to evaluate HMOs. Key areas include quality and appropriateness of managed care, the credentials of doctors and other medical providers, member rights and responsibilities, preventive care services and medical recordkeeping.

In addition, there are many comparisons of HMOs published by the media and non-profit groups each year. For instance, Newsweek, U.S. News & World Report and Consumer Reports have published national HMO comparisons. An online search should uncover these and others.