Issues like emergency room coverage, pre-existing conditions, and hospitalization limits will affect the kind of health care available to you. Find out if the plan provides direct access-if you will be able to consult directly with specialists of your choice or request special tests. The NCQA's mission is to improve the quality of HMOs, to show which organizations manage quality, not just cost. You should also investigate whether the hospital and laboratory your physician works with are accredited. Your physician, in addition to knowing very personal things about you, can help you as an advocate in working with the health care system.
Credentials Be sure to investigate the doctor's professional reputation.
Choice Remember that you, as a health care consumer, have a right to a second opinion or to change doctors. No Conflict of Interest Be sure that there is no conflict of interest that could compromise the quality of your care. An example of this is capitation, where a doctor is paid a set fee per patient regardless of the care given to each patient. Some fear that this may encourage physicians to limit treatment or tests in order to save money. A physician's credentials don't guarantee his or her competence.