Using This Guide > How Do HMOs Work? | How To Choose An HMO | Terms You Should Know | Data Sources | Types of Complaints | Crosswalk of Health Insurer Names | Worksheet to choose an HMO

How To Choose An HMO

How to Choose a New York HMO (a Step‑by‑Step guide)

Step 1
Identify your options.

You should narrow your focus and compare HMOs that:

• Your employer offers as a benefit
• Your doctor(s) participate in
• Offer care and service in the area where you live and work
• Have premiums, deductibles, and copayments that you can afford

Step 2
Determine which items are most important to you in an HMO, and evaluate and compare the HMO performance in these areas.

Use the worksheet to help you choose an HMO to gather information important to you.

How do HMOs rank based on complaints to the New York State Insurance Department?	Go to Complaints
Do providers and members get paid promptly?	Go to Prompt Pay Complaints
How often are HMO decisions to deny care or service changed?	Go to External Appeals
How often do HMOs pay for medical services that are considered experimental, investigational or medically necessary?	Go to Internal Appeals
Do HMO members have access to the care and service they need?	Go to Access to Care and Service
How well do HMOs help members maintain good health and avoid illness?	Go to Staying Healthy and Living with Illness
How is the quality of HMO providers determined?	Go to Quality of Providers
How do HMOs rank based on grievances to an HMO?	Go to Grievances

Step 3
Select an HMO.

After completing steps 1-2 you should be ready to select an HMO. 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.