The term “Medical Group” often means different things to different people. To some folks it may be a group of physicians of varied specialties sharing office space. To other people, it may mean a team of doctors that all practice at the same hospital. In the HMO world, however, neither of these definitions quite fit the bill.
In this case, a medical group is a cluster of physicians who have opted to team together to provide outpatient medical care to their covered HMO members. While on occasion these physicians will share a practice name and office space, oftentimes they do not. The medical group will have a separate name for their collective association and will likely all have staff privileges at the same hospital. It is typical for medical groups to have a close working relationship which leads to the efficient practice of medicine coupled with increased patient satisfaction.
When you choose an HMO as your health insurance carrier, you will be asked to complete an application for coverage. This application will ask some basic information such as name, address, date of birth and a listing of your dependents that you would like to cover under the policy. You will also at this time be asked to select a medical group. Sometimes the plan will ask for the group by name and other times it will ask for the group by a unique identification number that the insurance carrier has assigned to the medical group.
When choosing a medical group to list on your application there are several factors to consider. First, be sure to ask your HMO carrier or Human Resources Department (if your coverage is through an employer) for a directory of medical groups. Review this directory carefully and narrow your selection to those groups that are geographically desirable based on where you live. Next, if you have an established relationship with a primary care physician (“PCP”) you will want to see if their name is listed within the directory. If it is not, you will need to begin receiving services from a new doctor. Also, the medical group directory will list the hospital that each medical group is tied to. If you have strong feelings about what hospital you prefer, be sure to take that into consideration as well. Finally, if you have no clue as to what medical group to select you can ask the HMO for an assessment that shows those medical groups that perform exceptionally well. On a regular basis the HMOs survey their members to find out if they are satisfied with their chosen medical group. They will query their members concerning topics such as ease of getting a referral, timely claims payment, and how quickly they can get an appointment.
If you have a chronic illness, such as allergies, be certain that the medical group you are considering has a panel of specialists that you are comfortable seeing. Remember, when you are in an HMO you can only seek services outside of your PCPs office with a referral and you will only be issued a referral to physicians within the same medical group. For instance, if your PCP is with ABC Medical Group and the allergist you have seen for years is with XYZ Medical Group chances are you will not be able to continue to see your established allergist.
Once your HMO application is completed, including your medical group choice, you will be mailed insurance identification cards within a few weeks. When you receive your identification card your medical group selection will be listed on the front of the card. Be sure to check this card for accuracy and if the wrong group is listed contact your HMO immediately.
Written by Sue De La Bruere
