Insurance and HMO Information:

Washington State health insurance companies offer many types of plans/products, including:

·         Preferred Provider Organizations (PPOs)

·         Exclusive Provider Organizations (EPOs)

·         Place of Service (POS)

·         Health Maintenance Organizations (HMOs)

SMA encourages patients to combine SMA membership with insurance coverage for costs such as laboratory, diagnostic tests, specialists care, emergency and hospitalization costs outside of SMA care. SMA works best with PPO, POS and EPO plans; it does not work as well with HMO plans. HMO plans limit your SMA clinician's ability to order, provide referrals, direct and coordinate your care. If you are enrolled in an HMO, you are required to obtain referrals and orders through your HMO assigned primary care practitioner. This added complexity may be challenging in times of navigating complex care needs.

 Washington State health insurance companies and the WA State insurance exchange (Washington Healthplanfinder) offer many types of plans/products. Most health plan types are compatible with the Seattle Medical Associates practice model.  A specific exception is the HMO plan/product type.  SMA can only accept patients with HMO plans if they have also established care with a primary care practitioner within their HMO plans network. Additionally, these patients must understand that all referrals and lab orders must be completed by that primary care practitioner, per State of Washington regulations. SMA physicians are not allowed, as a direct practice clinic, to be considered in-network primary care practitioners in these HMO plans.

 HMOs require their members to use specific healthcare practitioners within their network. HMO patients must select an HMO primary care provider (non-SMA practitioner) to direct all of their care (Referrals/ diagnostic orders).  Please note that many plans/products offered through the Washington State insurance exchange (Washington Healthplanfinder) are HMOs. On the exchange, you may also be able to locate and choose a PPO, EPO, or POS plan. As you select a health insurance plan that best meets your needs, questions may arise. We advise you to consult with your health insurance broker or the specific health plan for clarification regarding your needs and further identification of their plan types, e.g., HMO, PPO, EPO, POS, etc.