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Texas Department of Insurance
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Choosing an HMO

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? Call NCQA at 888-275-7585.

Learn more

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, call our Help Line at 800-252-3439.

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 or call at 512-322-4143.

Guides

More HMO information

More health care links

For more information, contact: LHLMgmt@tdi.texas.gov

Last updated: 1/19/2021