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What is an Open Panel HMO?

A HMO benefits summary.
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  • Written By: Malcolm Tatum
  • Edited By: Bronwyn Harris
  • Last Modified Date: 03 August 2014
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An open panel HMO is a health maintenance organization that allows individual physicians to participate in the program through the auspices of an independent practice association. A physician who participates in an HMO is this manner is free to see patients who are not connected with the organization and is not committed to taking on a patient simply because he or she is with the HMO. This is in contrast to a closed panel HMO, in which the physician is directly linked to the HMO and is under contract to any and all HMO members who are assigned to the doctor by the organization.

An open panel HMO was not part of the original design for a health maintenance approach to healthcare coverage. The concept of the health maintenance organization dates to the early 1970’s in the United States. Initially, HMOs functioned as a means of providing in network health care. That is, persons covered under the terms of the HMO were assigned to specific doctors and were free to use any medical facilities that that had contracted with the HMO provider. In later years, the coverage was broadened to allow members to see any physician who had contracted with the HMO directly.

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Open panel HMO structures began to appear in the 1980’s and 1990’s. There were several advantages to this arrangement for both patients and physicians. The patient was able to pay a fixed fee in exchange for quality medical care, and has the ability to choose from a wide range of physicians to be the primary care provider. This was in contrast to the earlier provision that in order for medical costs to be covered, the patient had to use only HMO contracted physicians and medical facilities.

For the physician, the open panel HMO meant it was no longer necessary to contract directly with the HMO in order to see patients with this type of coverage. He or she could simply contract with an intermediary group practice HMO association that had contracted with the HMO and be able to see HMO patients and be paid for services rendered. At the same time, the physician is still able to refuse any patient associated with the HMO if he or she feels the action is warranted, without incurring any censure. Doctors who wish to continue treating a patients outside the confines of a health maintenance organization often prefer to go with an open panel HMO arrangement.

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Discuss this Article

Misscoco
Post 4

@lovealot - The HMO that you described sounds very interesting. We have four children and I'm always having to take them to the doctor. It would be great to have prescriptions and doctors all under one roof.

It would give one piece of mind to know that surgeries and hospitals stays are completely covered.

i assume there wouldn't be all the insurance paper work and co-pays and stuff that you have to do with regular insurance companies.

lovealot
Post 3

I know a number of people who belong to an unusual HMO health insurance organization. I don't think that there are too many like this HMO in the U.S. It's organized as a separate entity. They have their own clinics, hospitals, rehab centers, pharmacies, and medical equipment facilities.

The organization has their own doctors, nurses, specialists and surgeons. The doctors treat only the members and members go only in-network. It is a huge organization and members pay a reasonable premium. Most medical services are paid for, but there are a few limitations.

To go to a specialist, you need to get the O.K. from your primary care physician. Most hospital stays and surgeries are taken care of. Prescriptions costs are paid for. It is a complete one-stop medical visit.

One draw-back is you basically have no choice in doctors or treatment. This approach appeals to lots of people as this health program has been successful for over 40 years.

JaneAir
Post 2

@KaBoom - HMOs definitely aren't for everyone. They are an excellent idea in theory but in practice they can be a pain for customers.

As for doctors, open panel HMOs can actually work quite well. Being part of an HMO can bring a doctor a lot of business but it's always better to have autonomy over your own medical practice. Being free to see patients from the HMO and elsewhere and to turn away HMO customers gives the doctor free rein to run their practice how they wish.

KaBoom
Post 1

I have an HMO and I just hate it! I'm not sure if my HMO is open or closed panel but I know I need a referral to do anything and I'm only allowed to see specific doctors. I know every health plan is different but my plan is really strict. It is a little bit cheaper than the PPO option but not by enough to justify the hassle!

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