How to Use Your HMO Card for a Doctor's Visit

Book with a doctor your HMO accredits, then bring your HMO card and a valid ID and show both at the front desk before you see the doctor. For lab tests or procedures, ask the clinic about an LOA, your HMO's approval, before you pay for anything.

An HMO, short for health maintenance organization, is the company behind the card your employer gave you. It pays the doctors and clinics it accredits for the care your plan covers. Using the card the first time can feel awkward, but front desk staff handle HMO patients every day.

Before you book

A few checks save you a wasted trip.

• Make sure your card is active. If you just joined the company or added a dependent, ask HR if it's working yet.
• Know what your plan covers. Ask HR, check your plan booklet, or call your HMO. Plans differ, so don't go by what a friend's card covers.
• Check that the doctor is accredited by your HMO. A doctor may take your card at one clinic and not at another, so check the clinic too.
• Tell the clinic you'll use your HMO card when you book, and ask if they need anything from you before the visit.

What to bring

• Your HMO card, or the digital card if your HMO uses one
• A valid ID with your photo
• Your company ID, since some clinics ask for it
• Any doctor's request or past lab results related to the visit

Dependents usually have their own card. Bring that one, not the employee's.

At the clinic

Tell the front desk you're using your HMO card before you're seen. The staff will check your card with the HMO, which can take a few minutes.

You may be asked to sign a form that confirms the visit. Read it first, and only sign for services you actually got.

If the staff asks you to pay, ask what the charge is for. Some plans have a co-pay or items they don't cover, and it's fair to know before you pay.

Lab tests and procedures (LOA)

An LOA, or letter of authorization, is your HMO's approval for a test or procedure your doctor asked for. Clinics usually need it before they run the test under your card.

The usual steps:

1. Get the doctor's written request.
2. Ask the front desk to request the LOA, or ask how you can request it yourself.
3. Wait for the approval before you take the test.
4. Check what the LOA lists and until when it's valid.

An LOA usually covers only the tests written on it. If the doctor adds a test later, you'll likely need a new one.

Emergencies

In an emergency, go to the nearest ER. Don't delay care to check your coverage.

Show your HMO card at the ER when you can, or ask a family member to do it. Let your HMO or HR know about the visit once you're able.

If the hospital isn't accredited by your HMO, keep every receipt and your medical records. Ask your HMO what papers they need, since some plans pay back part of emergency care.

If a clinic says your card isn't accepted

Ask the staff for the reason. It's usually one of these:

• The doctor isn't accredited by your HMO at that clinic.
• Your card isn't active yet, or it has expired.
• The service isn't part of your plan.
• The clinic couldn't verify your card with the HMO.

Then call your HMO, whose number is usually on your card, or ask HR. They can tell you what went wrong and where to go instead.

If you decide to pay on your own, ask for an official receipt and your medical record in case your plan allows reimbursement. If you need to see someone today, you can consult a doctor online. Ask your HMO whether your plan covers online consults.

Find a doctor who takes your card

This directory lists doctors by the HMO cards they accept, so you can start from your card instead of guessing. Browse doctors who accept Maxicare and Intellicare, or pick your HMO from the categories on this site.

When you're ready to book, you can find doctors by HMO on NowServing. Accreditations change, so confirm with the clinic that the doctor still takes your card before your visit.