HMO plans affect doctors in a few ways.
When healthcare providers work with an HMO network, they get paid a fixed rate for certain medical services, treatments, and testing. They can’t set their own rates for each service, which is why HMO premiums are usually affordable.
Additionally, most HMO models prohibit doctors from seeing patients that aren’t in the network. For that reason, not all healthcare facilities accept HMO coverage.
“Some doctors choose not to take HMOs at their practice for administrative or financial reasons. The referral responsibility creates additional work for primary care providers as well,” Decker says.