Answer: Emergency claims

are billed to the HMO regardless of where they occur,

provided the situation is a true emergency. Non-emergency

cases must have the prior approval of the HMO.

Question: Are HMO members

responsible for bills sent to them by a doctor or

hospital?

Answer: Generally, no.

Providers are prohibited by law from billing members for

covered services rendered. They may, however, bill

members for uncovered services, which would be any

treatment not listed in the HMO contract, or which was

not otherwise authorized by the HMO.

Question: What are the

advantages or disadvantages of getting health coverage

through an HMO?

Answer: With an HMO there

are no large deductibles, and only small copayments.

Also, members are not required to fill out lengthy claims

forms. Some of the disadvantages include being limited to

the HMO's designated hospitals and doctors. Members

generally cannot use specialists without a referral from

their primary-care physician. Also, if you have children

who are attending college outside the service area of

your HMO, they may not be eligible for coverage.

Please send your insurance

or fire safety questions to: Insurance and Fire

Commissioner John Oxendine, 716 West Tower, 2 Martin

Luther King Jr. Drive, Atlanta, GA 30334.

Or call 404-656-2070 (toll

free at 1-800-656-2298) for assistance with an insurance

question. TDD services available at 404-656-4031.

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