Quote:
Originally Posted by blueash
You are confusing an HMO with a capitated plan. While some HMO's operate on a capitated basis, most do not. The major difference is that in an HMO you only have coverage in network and no benefits if you go out of network. In a PPO your benefits are better in network but you have some coverage if you stray. In an HMO non-capitated plan the doctor bills on a fee for service basis just as he would in a PPO
However even in a capitated plan, no doctor is paid to not see patients. Rather the doctor is paid the same whether you are seen or not as he receives a pre-determined amount per month for managing your non-specialist care. Only if he keeps you happy will he continue to receive this monthly amount so not seeing you certainly will cost him money.
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While I really don't have a reason to question what you say, I am going strictly by previous experience an HMO. You are right. They are paid a set amount per patient. Therefore, the more patients they see, the more money they get. To me, that translates to less time per patient. They are also constrained by the number of referrals to specialists they make.
This happened to us in Texas when our plant coverage was with an HMO. Our doctor that we had had for years chose not to participate and we were forced to change doctors to have coverage. Long story short, we received a letter from this doctor one day saying that he had been ordered to cut his number of First Care patients because he was making too many referrals. By then, our original doctor had joined because so many of his patients were employed at the same plant we were. We went back to him. Fortunately, for us, he was able to basically beat them at their own game and get the care he needed for ALL his patients.