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Consumer Survey Rates HMOs

Medical care options can be confusing, especially when it comes to deciphering the different services provided by HMOs. But a new Consumer Reports survey sheds light on what experiences patients have had with various organizations.

Trudy Lieberman, the health policy editor at the publication says the survey asked readers to evaluate their HMOs' performance.

"We wanted to find out such things as how easy it was to get tests, referrals to specialists, how responsive the plans were when it came to solving grievances, how the people liked their doctors and how they liked their plans," she told CBS News.

The survey found that the top plans handled complaints and problems in a more responsive manner, and were more attentive to preventative care. People in the top plans tended to like their selection of doctors and specialists.

The difficult question for most people is whether an in-network or out-of-network plan works best for them. Point-of-Service, or POS plans, allow patients to go out of the HMO network of physicians to see any doctor or specialist they want. But there can be pitfalls with this option, Lieberman says.

"You might get stuck with a very large bill that you hadn't expected," she says. "Doctors bill a certain amount and the HMO will only pay what is called an 'allowable charge.' On that allowable charge they will apply 80 percent or 70 percent."

In effect, if the HMO has a very small allowable charge, patients may be responsible for a large portion of the bill.

However, staying in-network can also present problems, Lieberman says.

"You might go to an in-network hospital for surgery, but the radiologist who takes pictures and takes your x-rays would be an out-of-network doctor," she explains.

Patients should ask how much procedures -- especially elective surgery -- will cost, before they go forward. If the price is too high, they may be able to negotiate with their doctor.

Often, patients will get a bill from their in-network doctor. Lieberman says most of those doctors are paid by the HMO and should not be billing patients.

"We found many were doing it anyway," she says. "Their computers were automatically doing it anyway. Our advice is to not pay the bill Â… Ask the HMO to help you, ask the doctor to not continue to send you the bills."

For those faced with choosing an HMO, she advises them to pick the plan that will be least expensive for the patient. However, POS plans should be considered as well. Although they may cost more, they allow more flexibility to go to doctors outside the network if necessary.

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