HMO or PPO?

[Jack_Dawson]

Which one should I choose? Discuss.

[Blue-Jay]

1. PPO costs a bit more, but you get a lot more freedom.

It's worth it to me. I get to choose my primary care physician, and there's a lot less hassle if you need a referral or a specialist.

[Jack_Dawson]

4. Plus I hate my PCP

So PPO might be good...

[Blue-Jay]

5. If you can afford the extra dollars, the PPO is worth it.

I'd only go with an HMO if that were my only option.

[Jack_Dawson]

6. It'll be a $50 difference/mo.

Can I really go anywhere w/ a PPO?

[Blue-Jay]

7. Mostly.

If you're on a Blue Cross/Blue Shield plan, you can choose any doctor that accepts BCBS. Almost all doctors do, as it's good for business.

[barb162]

26. I agree; the choice is well worth it, especially if you have a

problem. ANy old time a person can get in an accident, need a specialist, and you want to be able to choose.

[ScreamingMeemie]

2. PPO...here is my story.

HMO= They told me my pregnancy losses were elective and that they weren't going to cover them. And then told me I didn't "get a referral" for an emergency D&C... Too much time wasted with GP's who may or may not refer you.

PPO= better coverage even if we pay a bit more of prescription copay. The best part is that we do not need referals and don't have to go to "network" hospitals.

[Jack_Dawson]

3. Wow - good advice

HMO = $20/mo
PPO = $70/mo

[idgiehkt]

8. yes to the GP's who may or may not refer

I had a very bitter argument with an ear, nose, and throat doctor in trying to get a referral to someone I wanted to see...he said it wasn't protocol and he wanted to refer me to an oral surgeon. In the end he refused, which infuriated me, because I felt it was my right to try a less drastic kind of treatment. I will never use anything but a PPO again if I can help it; it still makes me mad when I think about how arrogant that Dr. was in not giving me a referral. :mad:

[Jack_Dawson]

12. That does it! PPO it is.

:beer:

[barb162]

27. Wise decision

[MistressOverdone]

9. HMO if it is a good one.

They can actually be quite good advocates.

[hippywife]

14. Really? For who?

I use my insurance quite a bit, unfortunately, and I've never seen them be a good advocate for anyone.

[MistressOverdone]

15. Our HMO is rated one of the best in the country

and in my extended family we have used it for everything from cancer (3X) to mental illness, substance abuse rehab, and even a transplant. The patient advocate is great at helping you cut through the red tape and none of us have ever been denied specialists. The only thing I ever had to pay for was a private room over a double in the hospital, and we've had this company (it is a subsidiary of BC/BS) since the early 80's. And the same doctor, who has treated four generations in my family (my parents, my husband/me, my kids, my grandkids). He'll send us for tests (for example he insists I get an internal ultrasound yearly because my sister had ovarian CA) without blinking, and to specialists with no complaint. I've had sleep studies and cpap therapy. I just can't complain. We are extremely fortunate. And when I retire, I am still in the system, although I will have to pay some out of pocket until I hit Medicare.

[Jack_Dawson]

16. OK, give it up

What's the HMO?

[MistressOverdone]

17. It is called

Capital Health Plan and it is in Florida.

[Jack_Dawson]

18. Well a hell of a lot of good...

that does me in CA! :-)

Thx though - sounds like you've got one of the "good ones".

JD

[Gormy Cuss]

21. "if it is a good one" -- that's the key, unfortunately.

Twenty years ago most HMOs were better than PPOs or indemnity plans, but as HMOs became the preferred form of health insurance too many pencil-sharpening MBAs took charge of medical care decisions. You are fortunate to have a good one available in your area. They're not all bad but increasingly there seem to be more stingy HMOs that ones who still believe in health maintenance.

[Silver Swan]

10. If you are never ill, an HMO is fine

I was in an HMO for twenty years. It was great for rountine things like annual exams, but it was horrid for anything else, like actual illness. I found that I usually had to diagnose myself, and allege every possible symptom associated with such diagnosis before my doctor would take me seriously.

I was tired of having to call and ask for permission to visit the emergency room, and then have to appeal when they denied payment after they had approved the ER visit.

I have been in a PPO for the past eight years. It costs a little more, but at least I don't have to beg for treatment for an illness.

[Jack_Dawson]

11. So...you just contradicted yourself

If I'm reading this right - HMOs suck, and PPOs rule. Oh you're being sarcastic...I get that now. Not too quick today, me.

[Deja Q]

13. Most people seem PPO'd at HMOs...

You know, pretty pissed off... :wow:


And you know me, I'm just HMOphobic... :wow:

:rofl:

[bridgit]

19. PPO...

[LeftyMom]

20. Probably the PPO.

Especially if the HMO is Kaiser. Kaiser sucks and blows, and at least around here all their good doctors (not that they had that many) seem to be leaving.

[dropkickpa]

22. I chose the HMO in my plan

MUCH more economically feasible. Of course, my health plan owns 95% of the hospitals in my area. They have just gone to a no referral needed system, with a flat copay of $20 per visit (used to be $15 with ref $30 without). My PCP is a tireless advocate, and has never hesitated to send me where he thinks I'll get the best help. They paid all costs (except for copays $10 for regular doc, at the time $15 for my onco) when I had cancer, and have been great about getting a shady hospital (out of town ER visit) to call off the collection dogs, and have even initiated a fraud investigation into them, they've really gone to the mat for me.

I pay $105/month for me and Dropkid, and it has been so worth it. They pay 100% for allergy testing and shots (needed in my household), all surgical procedures are covered (including the removal of a couple moles), and all vaccinations are fully covered. I have access to many of the top-rated specialists in the country if need be.

ER visits are covered by a $30 copay no questions asked at their hospitals (again, they own just about every hospital in the city), and so long as I get a call to them within 24 hrs they cover all ER bills at out-of-network hospitals.

BUT, my plan is probably not the norm nation-wide. I am damn lucky, and know it. This is probably why I put up with the lousy pay, the benefits (health is just one) make up for a lot of it.

I would research what their "network" consists of. Here, the network covers any and everything I could ever possibly need (not to mention my PCP is part, so it made it that much easier to make that decision), so the PPO just would not make any sense for me.

[latebloomer]

23. I always go with a PPO

even though I'm self-employed and have to buy my own insurance, so it's much more expensive.

If you get really sick you are stuck, in an HMO, with the doctors on your plan. There might be a wonderful doc who everybody recommends, but, if he's not on your list, you're shit out of luck.

[Jack_Dawson]

24. How much more...

Is a PPO for you than an HMO? Juss wonderin'

[latebloomer]

25. Not exactly sure

But I think a few hundred dollars more a month-- for a family of four.

[Jack_Dawson]

28. Dang!

Families are expensive shit!

Signed,

Single