When you enroll in an HMO, you select a primary care physician from the list of providers in the HMO network to oversee your health care. If the services of a specialist are required, your primary care physician refers you to one. As an HMO member, there are no deductibles to satisfy or claim forms to file, and you should not receive doctor or hospital bills. However, most HMOs require you to pay a small co-payment for doctor visits, emergency room visits, emergency room treatment, and other services. The plan has a network of doctors, hospital, and other health care providers who offer medical care in cost-efficient ways.
All providers undergo a credentialing procedure prior to becoming part of the network.
The NJ PLUS network covers all of New Jersey and Delaware, parts of Pennsylvania, and New York. When you use this doctor or other network providers, you pay a five dollar co-payment after which your medical expenses are generally covered in full. There are no claim forms to file. But there is an important difference. Occasionally, situations arise where a member feels that his or her medical care or claims have not been properly handled by his or her health plan.