CPB Certified Professional Biller Certification Practice Exam

What did the Amendment to the HMO Act of 1973 allow federally qualified HMOs to do?

1. Completely restrict patients to in-network physicians

2. Permit members to use non-HMO physicians occasionally

3. Eliminate all reimbursements for out-of-network services

4. Reduce member access to healthcare services

The correct answer is: Permit members to use non-HMO physicians occasionally

The Amendment to the HMO Act of 1973 allowed federally qualified Health Maintenance Organizations (HMOs) to permit members to use non-HMO physicians occasionally. This was a significant change designed to increase flexibility for patients who were previously restricted to in-network members for their healthcare needs. By providing the option to access non-HMO physicians, the amendment aimed to balance the benefits of managed care with consumer demand for greater choice in healthcare providers. This flexibility acknowledges the reality that patients might need or prefer to seek care outside their managed care networks for various reasons, including specialization or personal preference. The amendment helped shape the evolution of HMOs by promoting accessibility while still encouraging the use of in-network services.