Choosing an HMO is similar to shopping for any product. Get details for the plans you are considering. Carefully review the HMO's information for current and prospective group contract holders and members, especially the benefits booklet.
Ask the HMO's representative or your employer's health benefits coordinator these questions:
- Which doctors in the HMO's network are accepting new patients?
- Is my current doctor on the doctor list?
- What specialists can I see?
- Which hospitals belong to the network?
- Where are the doctors and hospitals located?
- What will my expenses (premiums and copayments) be?
- How many members left the health plan last year?
- Has an independent accrediting organization, such as the National Committee for Quality Assurance (NCQA), evaluated the HMO? (NCQA's Health Plan Report Card) Call NCQA at 1-888-275-7585
Review the HMO's doctor list and confirm that the doctor you're considering is accepting new patients. The HMO's doctor list must identify the doctors who are not accepting new patients.
To learn about complaints filed against the HMO you're considering, visit TDI's website www.tdi.texas.gov or call TDI's Consumer Help Line at
In Austin, call 463-6515
Servicio en español
If you have a hearing or speech impairment,
call Relay Texas at 1-800-735-2989 (TDD/TT)
The Texas Office of Public Insurance Counsel (OPIC) issues an annual report that allows consumers to compare and evaluate HMO plans in Texas. (OPIC's HMO Report Cards) The report contains results of a survey asking HMO members how they rate their plan, the quality of care they receive, and the doctors and specialists in the plan. The report also compares
- HMOs' service quality
- how easy it is to obtain referrals to specialists in HMOs' networks
- the level of complaints filed by patients and doctors against HMOs
- independent review appeals of HMOs' decisions
To view OPIC's report on HMOs, visit OPIC's website www.opic.state.tx.us or contact OPIC at
Office of Public Insurance Counsel
William P. Hobby Building
333 Guadalupe, Suite 3-120
Austin, TX 78701
(From TDI's Publication Health Maintenance Organizations)
- Health Maintenance Organizations
- Independent Review Organizations
- Senior Issues
- Small Employers Health Insurance: Questions and Answers
- Your Health Care Coverage
Other Brochures of Interest
More HMO Information
- Notice to HMO Patients [PDF Version]
- Complete HMO Financial Data
- Federal Medicare Managed Care Information
- HMO Complaint Summaries
- HMO Mandated Benefits/Offerings
- HMO Search by County
- HMO Profiles
- HMO/Insurer Profiles
- Listing of Certified Independent Review Organizations
- Office of Public Insurance Counsel's HMO Report Cards | En Español
- NCQA's Health Plan Report Card
- Texas Health Care Information Council's Straight Talk on Texas HMOs
- Texas Medicaid HMO Information
More Health Coverage Links
- CHIP - Children's Medicaid - combines several health insurance campaigns developed especially for Texas children from birth through age 18. It includes the Children's Health Insurance Program (CHIP) and Medicaid for Texas Children.
- HCFA - Federal HIPAA Insurance Reform
- Texas Health Insurance Risk Pool - provides a source of health coverage for uninsurable persons and their dependents or family members and for certain individuals who lose their employer-sponsored health coverage.
- Texas Department on Aging & Disability Services - Health Care and Other Services
For more information contact:
Last updated: 10/15/2012