Health Maintenance Organization (HMO)

Also called: HMO

A health maintenance organization is a plan that keeps costs down by limiting you to a defined network of providers and, in most cases, asking you to pick a primary care doctor who coordinates your care. Seeing a specialist often requires a referral, and care outside the network is generally not covered except in emergencies. Denials in an HMO frequently trace back to a missing referral or an out-of-network visit.

Facing This in a Denial Letter?

Our free AI-powered tool can help you turn a confusing denial into a compelling appeal letter in minutes.

Disclaimer: This definition is provided for general educational purposes only and is not legal, medical, or insurance advice. Insurance rules, deadlines, and terminology vary by plan, state, and over time. Always check your own plan documents and confirm current details before acting.