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Subscribers to an HMO receive medical services from participating
physicians, clinics and hospitals. You choose a primary care physician
from a list of participating doctors. That doctor is used for typical
circumstances such as annual exams and usual health issues. If you need
to see a specialist, be hospitalized, or have lab or X-ray work, your
doctor will refer you to a provider or facility within the HMO system.
Your doctor must give authorization for those services to be covered by
your HMO. In other words, you must see HMO approved physicians
and use HMO approved facilities or pay the entire cost of the visit
yourself.
You may have to pay some portion of the cost (co-payment) for each
office or hospital visit, such as $10 - $15 per doctor visit, regardless of
what the services cost. Also, some services such as emergency room,
mental health and chemical dependency services, may carry additional
costs in an HMO health maintenance plan. **
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