Only services authorized by the PCP are covered. HMOs do not require payment of deductibles. Usually, however, there are minimal copayments for office visits and certain other select services, such as prescriptions. The providers agree to provide services at contracted rates in return for having network referrals channeled their way. Preferred providers must agree to a discounted fee schedule in exchange for preferred status and must comply with certain utilization, management and other operational guidelines.
Physicians usually remain geographically independent.
The HMO reimburses the IPA on a capitated basis, although the IPA usually reimburses the physicians on a fee for service basis. An HMO that owns and operates health centers staffed by physicians employed directly by the plan. HMOs that meet certain federally stipulated provisions aimed at consumer protection, such as providing a broad range of basic health services, ensuring financial solvency and monitoring quality of care. But hospitals keep any excess revenues that occur when length of stay or resources expended are less than typical. The county-specific Medicare risk premium paid by HCFA to contract with a health plan.