Kevin McNamee, DC, LAc and Karen Magarian, MA, DC Managed care is here to stay in the American health insurance industry. An estimated 80 percent of all insurance coverage has some form of managed care component.
Caution is recommended to new practitioners when signing with HMOs.
The HMO's fee schedule, which is the rate you will be paid for your services, will lock you into a rate which that not allow you to afford the much-needed additional staff. HMOs offer a fee for your services based on what they can sell to insurance companies and employers while offering you the lowest dollar. Carefully examine the HMO's fee schedule to determine whether you can make a profit. Joining an HMO with a fee schedule that causes you to lose money, or barely break even, is clearly an unwise business decision. It also says to the health care industry that you are able to stay in business with the HMO's fee schedule, and that you will accept it.