They pay the bill. They file a claim with their insurer. Go to the hospital 1. They pay the bills, which typically arrive separately from the hospital and from physicians. They file claims with their insurer.
Insurer reimburses patient for payment above deductibles.
Go to the pharmacy 1. The pharmacy then bills the insurer for the balance, which usually reflects a discounted rate the two parties have negotiated. The HMO pays the doctor or group, usually at a negotiated rate below the doctor's regular fee. Go to the hospital 1. The HMO pays the hospital and physicians, usually at discounted rates.