In 2014, the NHIS required all of their accredited HMOs to go through a re-accreditation process. The point of the process was to raise standards across the board, with the intent to bring higher quality healthcare to Nigeria. Surveys show that most Nigerians are for the most part happy with the newly revamped HMO system.
What is an HMO?
HMO is the abbreviation for Health Maintenance Organization. With an HMO plan, you get to pick your own Primary Care Physician (PCP). Should you develop any health problems, you go to your PCP first. If the issue requires the help of a specialist, your PCP will point you in the right direction.
How does it work?
If you have back pain and you have an HMO-based health care plan, you would first schedule an appointment with your PCP. If your PCP can’t help you with your problem, he or she would then schedule an appointment with a doctor who specializes in helping people with back problems.
Do HMOs in Nigeria cost more or less compared to other kinds of health care plans?
Generally, HMO-based health care plans cost less because many conditions can be easily treated by a physician. Because physicians charge less for their services compared to specialists, the health insurance company saves money. Those savings get passed down to policyholders. That’s why HMO-based plans usually require less out-of-pocket payments, compared to other kinds of health care plans.
HMOs in Nigeria: are there any downsides?
If you have an HMO plan, you have to get a referral before visiting a specialist. If you can’t get a referral, that means that you have to settle for whatever treatment your PCP offers you. Some Nigerians have reported that their PCPs always respond to their questions in a dismissive manner or with a mouthful of medical jargon that’s hard for the average person to understand. Both PCPs and patients must be willing to work together to come up with health solutions.
What if there’s a problem? Who can I call?
HMOs in Nigeria are now placing a greater emphasis on customer service. If a problem should arise between a patient and hospital staff, the HMO’s customer support center gets involved to settle the dispute. A ticket is generated by customer support and then it isn’t closed out until a solution has been reached. Common complaints involve clerical errors or misunderstandings about what kinds of services are or are not covered by the HMO plan. Turnaround times and feedback data are monitored to insure high quality customer service.
HMOs in Nigeria: Is an HMO plan right for me?
If you are someone who rarely needs to see a doctor, than an HMO plan may be right for you. If you require direct access to specialized health care, though, you may want to go with a different kind of plan.
good morning. if i didn’t go to my PCP before seeing a specialist, can i recover the amount spent from my HMO or if it was through referral from my PCP, who will bear the total spent?
Hi, it’s advisable to notify your HMO beforehand of any visit to the specialist. Usually your HMO or PCP will refer you directly to the specialist, and yes it is okay to let them know if you prefer a particular specialist.
Referrals from your HMO will be handled by them. PCPs will often always get permission from the HMO before referring you to any specialist as well. I’m afraid you may or may not get reimbursements for unapproved consultations. Your best bet is to discuss with your HMO about the condition especially if it was an emergency then hope for the best.
I am from Delta state. In my state the scheme is more or less fraudulently applied. We were not informed before the commencement of deductions from our salaries. We still go to private clinic to pay for our bills when we fall ill. The question here is what can we do about this?
Wish there was a website to rate the perfomance of HMOs.
It is so difficult getting this matter of selecting an HMO sorted.
Hi Spencer,
You may wish to read the article below.
https://www.medicalworldnigeria.com/2016/05/how-to-select-a-health-maintenance-organization-by-dr-o-adekola#.WCXZL8m2W00