How to Choose a New York HMO (a step-by-step guide)

Step 1 - Identify your options. To limit the burden of selecting one HMO from all New York HMOs, first narrow your focus. You should compare HMOs that: Offer care and service in the area where you live and work Your doctor(s) participate in Your employer offers as a benefit Have premiums, deductibles and copayments that you can afford

Step 2 - Determine which issues are most important to you in an HMO. This Guide provides answers to questions you may have when choosing an HMO: How do HMOs rank based on member complaints to the New York State Insurance Department? Do HMOs pay claims on time? How often are HMO decisions to deny care or service changed? Do HMO members have access to the care and service they need? How well do HMOs help members maintain good health and avoid illness? How is the quality of HMO providers determined?

Step 3 - Evaluate and compare the performance of the HMOs that are available to you. Each of eight HMO performance areas are presented in this Guide. They are: Complaints Prompt Pay Complaints Utilization Review Appeals External Reviews Access to Care and Service Staying Healthy and Living with Illness Quality of Providers Grievances You will learn what each performance area measured, how New York HMOs rate, and what the results mean. Tables compare each HMO's performance to the average performance of all New York HMOs.

Step 4 - Select an HMO. After you have looked at all the performance outcomes in the previous steps, you should be ready to select a plan. Focus on large rather than small differences when you compare plans. Basing a decision on a small difference may not change your family's health care experience.