View Full Version : HMO or PPO that is the question
Ok I have always been completely satisfied with the HMO and my doctors has all been accessible no problems, well until now, My arm is getting better by the day and I have been doing all the exercises that the doctor instructed to do which is good because the PT Center in my network, which there is only one of can't get me in for 3 to 4 weeks...HELLO...I need 2-3 days a week for two weeks.....well because I am HMO I need to get authorization to go to another PT facility....still no word on when that will be....
HMO TO PPO open enrollment starts next week....the PPO is 90/10 no more out of pocket per check, but how will this really affect me? I have never done the PPO, I do know that had I had it during all this arm ordeal I could have seen a doctor much faster and not had to suffer all the pain I did for those 5 days, and would be in PT all this and next week and be done.
This won't be effective until June so unfortunately it won't help my current situation....
I NEED OPINIONS from those who have had PPO and HMO.... I need input.
I have never done an HMO because we have long standing relationships with doctors and I refused to change. I like that I am the one that decides on which doctor I want to see. I don't need referrals either.
GO WITH PPO!!!!!!!!!!!!!!!!!! Okay, that's just my humble opinion, ;) but we've had so much less of that type of prob on the ppo than we did when we were on hmo. But, like I said, that's jmho! :lol:
Mickey
04-19-2007, 10:42 AM
Renee, I have found that the choices are limited with an HMO, but it may be cheaper for you (lower co-pays and lower out-of-pocket expenses).
I would ask for the following for each plan (HMO and PPO) your company offers:
1. Co-pays for both (including doctor's office visits, ER visits, and hospital stays)
2. Contribution percentage for both participating and non-participating doctors/facilities (it could be something like 90/10 (meaning you pay 10%) for in-network doctors/facilities and then as much as 60/40 (you pay 40%) for out of network doctors/facilities). There is still an approved network of participating providers for a PPO, so ask for the list to see if your doctors are on it. If they aren't on the list, you'll be responsible for the higher out-of-network percentage.
3. Deductibles (per person and per family per year).
4. Prescription plan information
Like I said, get these for each plan so you can cross-compare.
I have a PPO now and like it, but I had an HMO when I lived in San Diego (Kaiser) and loved it--never had a problem (they handled all the referrals and there happened to be no delays for me at the time) and my co-pays were $5/visit (this was 10 years ago) and I don't remember paying anything at all when ds was born. This time around for B's birth (on my PPO), I had to pay a $500 copay plus 15%. But I never had to wait for care on the HMO, though--that would definitely be a problem for me, so I can understand your wanting to look into another plan.
But all plans are different--if you're comparing an excellent PPO plan to an HMO you might think differently than if you compare a crappy PPO plan to an HMO.
Get the info on both options and do the comparison before you do anything.
MaryL
04-19-2007, 08:02 PM
GO WITH PPO!!!!!!!!!!!!!!!!!! Okay, that's just my humble opinion, ;) but we've had so much less of that type of prob on the ppo than we did when we were on hmo. But, like I said, that's jmho! :lol:
I totally agree...and we've had a great experience with our PPO. We haven't had any problems.
I totally agree...and we've had a great experience with our PPO. We haven't had any problems.
Our PPO has been changing lately... I should have added that. :( It's going more towards a 90/10 thing, rather than just the flat co-pays for ER, MD, Specialist, Hosp., prescriptions. I liked the flat co-pays, no deductible thing. You always knew what to expect. Still... it's less problematic so far than the hmo.
But all plans are different--if you're comparing an excellent PPO plan to an HMO you might think differently than if you compare a crappy PPO plan to an HMO.
AMEN
Ok, I spoke to five differnet people at the office, the concensious is that its a great 90/10 plan. No more out of pocket in your check, co pay is the same, percription plan might vary $5.00 for some medications.
I spoke with dh and since he has Kaiser (NOT Your typical HMO) he was all for me and the kids going the PPO route, if I hate it I can change again in 6 months....this won't take effect until June.
Oh And I got denied for the Physcal Therapy facility that the Doctor requested. I can go to the in network one on May 1st, so Doctor's office is looking for another PT facility to request.....what a pain, litterally.
Its 3-4 sessions for 2 weeks, but by the time I get PT it will have been four weeks since I had the shot of Cortizone. :rolleyes:
Oh And I got denied for the Physcal Therapy facility that the Doctor requested. I can go to the in network one on May 1st, so Doctor's office is looking for another PT facility to request.....what a pain, litterally.
Its 3-4 sessions for 2 weeks, but by the time I get PT it will have been four weeks since I had the shot of Cortizone. :rolleyes:
That really sucks, Renee. :( Our ins is a pita sometimes in that area, but only because we are so limited in our choices down here. When my doc finally decided that I needed pt for my back (a month after I hurt it) the only place my ins. co accepts had a two month waiting list. :rolleyes: Thankfully I was able to get in a lot sooner!
That really sucks, Renee. :( Our ins is a pita sometimes in that area, but only because we are so limited in our choices down here. When my doc finally decided that I needed pt for my back (a month after I hurt it) the only place my ins. co accepts had a two month waiting list. :rolleyes: Thankfully I was able to get in a lot sooner!
Pam what really stinks is that, that shot hurt like HELLO and it gave me about 90% of my range of motion back, but its still sore in some spots and stiff...so PT would be great, if I could get in to do it...I have been doing the exercises on my own, and I wonder if I would have had more success had I been able to get in and start on the PT...argh....its so frustrating....
and ya'll can't be on your dh's policy why?
Pam what really stinks is that, that shot hurt like HELLO and it gave me about 90% of my range of motion back, but its still sore in some spots and stiff...so PT would be great, if I could get in to do it...I have been doing the exercises on my own, and I wonder if I would have had more success had I been able to get in and start on the PT...argh....its so frustrating....
I wonder if the Ortho could give you some gentle exercises to do until you can get in to the pt?
Mickey
04-20-2007, 10:01 AM
I'm wondering what Ann is wondering...about going on your dh's plan.
Glad you are only committed for six months if you want to switch back.
and ya'll can't be on your dh's policy why?
well we could but it would cost more than I pay now.
He gets his 100% paid for which is great, but to add me and the kids, its $$
:happydnc: I got the call from the ortho doctors office they got me approved at a PT facility near work, so I can go on my lunch hour, I start Monday...:happydnc:
Finally going to get this arm back in to shape. (insert musle smiley)
:happydnc: I got the call from the ortho doctors office they got me approved at a PT facility near work, so I can go on my lunch hour, I start Monday...:happydnc:
Finally going to get this arm back in to shape. (insert musle smiley)
YES!!! :yippee: I'm so happy for you, Renee! I understand your relief!!! :)
MaryL
04-21-2007, 08:25 AM
and ya'll can't be on your dh's policy why?
Not speaking for the others, but I have my own insurance through my work, and dh has he and the dks on his through his work. I get mine paid 100% for a single policy. Dh gets a good deal having a parent/child plan through his work (kind of designed for single parents and kids, I suppose). Adding the family to mine is crazy expensive.
well we could but it would cost more than I pay now.
He gets his 100% paid for which is great, but to add me and the kids, its $$
so your premiums won't change if you go to a PPO? cool!
congrats on the PT!!!
Leigh
04-21-2007, 09:04 AM
WoooHooo!!! I am so happy for you!
Diane
04-21-2007, 09:13 AM
:happydnc: I got the call from the ortho doctors office they got me approved at a PT facility near work, so I can go on my lunch hour, I start Monday...:happydnc:
Finally going to get this arm back in to shape. (insert musle smiley)
:yippee: :yippee: :yippee: Good for you, Renee!!!! I'm so happy you're finally getting in. (and how nice is it that it's so close to work... :) ) What a relief that must be for you!!
Mickey
04-21-2007, 09:16 AM
So glad they got you in, Renee! And so close to work, too!
so your premiums won't change if you go to a PPO? cool!
congrats on the PT!!!
No it's werid I know, been over it with a fine tooth comb.....
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