We have had HMOs since my son's birth. (Actually I have been on several since I began employment after graduation.) Prior to childbirth, I didn't really use health insurance much so of course the preventative focus of the HMO was perfect for me. Since my son's birth we have had a few issues, but in the end I have been able to get all the medical care he needs (or I want) and be covered except co-pays. All-in-all, we have had a fairly positive experience.

One thing I have learned is Document, Document, Document. Take notes on every conversation you have. I keep a three ring binder with clear plastic page protectors. Every time I have an issue e.g. a bill to me that says referral denied, I start calling and jot down everyone I speak to and their phone number. It sometimes takes me several calls, but I have always been able to get it straigtened out.

Taking notes will help you find a person again if you need to speak with them. It will also help you fight a refusal of coverage if that case should ever arise. I also have found it very helpful to call back the same people - ask for them by name. They develop a relationship with you and will go to bat for you. An example, my son's pediatrician is in one clinic group, his endo is in another, and the hospital he gets blood drawn is in a third. Obviously, referrals are critical to getting his services paid for. I have a women I speak with regularly in the ped's referral office. She makes sure the paperwork is complete. I don't know what I will do if she ever leaves that office.

Also, make sure you find a good doctor. He or she may not like the paperwork of HMOs, but a good one will know how to navigate the managed care system while giving you the care you are entitled to.