HMO or PPO?
Apr 16th 2014, 4:50 pm
#16
Lost in BE Cyberspace
Joined: Jan 2008
Posts: 41,518
Re: HMO or PPO?
HMO is OK I think. People love to brag and show off about their specialists (as I keep saying), but nothing I've heard has convinced me they're actually getting better treatment. You just have to go through a primary care physician to access one. In my view, means they're less likely to be a charlatan.
Apr 16th 2014, 9:56 pm
#17
BE Enthusiast
Joined: Oct 2011
Location: San Diego, Ca
Posts: 333
Re: HMO or PPO?
Ok, it looks like the HMO might be the better option. The co-insurance is 10% less, so if something major were to happen my exposure is limited, plus the out-of-pocket is a lot less. All our current physicians are all in network, so no issues there. As far as being out of town / travelling and something happens I was told as long as I contact my primary care physician within 24 hrs it will also be covered even though out of network.
Does this sound right?
This is coming from their (prospective employer) HR department.
Does this sound right?
This is coming from their (prospective employer) HR department.
I had a baby on our HMO and the care was brilliant with very little out of pocket to me (We have a 0 deductable HMO so only pay co-pays). My out of pocket cost for the whole pregnancy, post natal care and delivery was only $400.
If we travel and something happens I just need to notify my PCP within 24 hours.
Apr 16th 2014, 10:41 pm
#18
Account Closed
Joined: Nov 2012
Posts: 1,570
Re: HMO or PPO?
HMO is OK I think. People love to brag and show off about their specialists (as I keep saying), but nothing I've heard has convinced me they're actually getting better treatment. You just have to go through a primary care physician to access one. In my view, means they're less likely to be a charlatan.
Contrast that with having to make an appointment to see my PCP, wait for appointment. Request a referral, wait 5-10 days for approval to be approved and then eventually go to the specialist. An additional amount of time spent off work sick while waiting for a procedure.
I'm not saying it is better treatment from medical viewpoint but it is a better treatment in terms of time frame. Getting me well and back to work in less time. But maybe being off work is not a concern for some, maybe even desirable?
I do not understand how you arrive at a specialists office is related to how "charlatan" they are likely to be.
Initially I had an HMO and got a referral to an ENT specialist. When later on a PPO i choose to use that very same ENT specialist. Same with a dermatologist.
Don't take this as bragging or showing off, I'm making a choice on what is best for myself and my family. And if people are asking about the difference between an HMO and PPO this type of response is totally relevant.
Apr 16th 2014, 10:45 pm
#19
Lost in BE Cyberspace
Joined: Jan 2008
Posts: 41,518
Re: HMO or PPO?
On my PPO i love being able to pull up a list of local specialists, choose which one i want and to go directly to the specialist if i so wish. Get treated ASAP and get back to work, minimal time off work sick.
Contrast that with having to make an appointment to see my PCP, wait for appointment. Request a referral, wait 5-10 days for approval to be approved and then eventually go to the specialist. An additional amount of time spent off work sick while waiting for a procedure.
I'm not saying it is better treatment from medical viewpoint but it is a better treatment in terms of time frame. Getting me well and back to work in less time. But maybe being off work is not a concern for some, maybe even desirable?
I do not understand how you arrive at a specialists office is related to how "charlatan" they are likely to be.
Initially I had an HMO and got a referral to an ENT specialist. When later on a PPO i choose to use that very same ENT specialist. Same with a dermatologist.
Don't take this as bragging or showing off, I'm making a choice on what is best for myself and my family. And if people are asking about the difference between an HMO and PPO this type of response is totally relevant.
Contrast that with having to make an appointment to see my PCP, wait for appointment. Request a referral, wait 5-10 days for approval to be approved and then eventually go to the specialist. An additional amount of time spent off work sick while waiting for a procedure.
I'm not saying it is better treatment from medical viewpoint but it is a better treatment in terms of time frame. Getting me well and back to work in less time. But maybe being off work is not a concern for some, maybe even desirable?
I do not understand how you arrive at a specialists office is related to how "charlatan" they are likely to be.
Initially I had an HMO and got a referral to an ENT specialist. When later on a PPO i choose to use that very same ENT specialist. Same with a dermatologist.
Don't take this as bragging or showing off, I'm making a choice on what is best for myself and my family. And if people are asking about the difference between an HMO and PPO this type of response is totally relevant.
Apr 16th 2014, 10:48 pm
#20
in Northern California
Joined: Apr 2014
Posts: 284
Re: HMO or PPO?
Contrast that with having to make an appointment to see my PCP, wait for appointment. Request a referral, wait 5-10 days for approval to be approved and then eventually go to the specialist. An additional amount of time spent off work sick while waiting for a procedure.
I'd be pretty upset if I was off work for 2 weeks waiting for paperwork. But that has never been the case.
Apr 16th 2014, 10:59 pm
#21
Northern Monkey!
Thread Starter
Joined: Feb 2006
Location: Jacksonville, Fl
Posts: 530
Re: HMO or PPO?
How are you supposed to let the PCP know within 24 hours if, say, this happens on a Saturday evening?
Last edited by jibsymalone; Apr 16th 2014 at 11:47 pm.
Apr 16th 2014, 11:10 pm
#22
BE Enthusiast
Joined: Jul 2013
Posts: 417
Re: HMO or PPO?
The main problem is not with the specialists, but actually getting an appt with the primary care physician. It takes a while if you want to see your assigned doctor, rather than who is available.
Bu tI heard that is the same for most primary care places, even with PPOs
Apr 16th 2014, 11:17 pm
#23
in Northern California
Joined: Apr 2014
Posts: 284
Re: HMO or PPO?
My PCP's office has two Docs. I know both and am happy to see either. The pediatricians office has nine Docs but with 3 kids and 10 years, I'm met all of them! No problem getting in to see one that I know and feel comfortable with.
Apr 17th 2014, 12:04 am
#24
BE Site Lead
Joined: Aug 2004
Location: MA, USA
Posts: 92,170
Re: HMO or PPO?
On my PPO i love being able to pull up a list of local specialists, choose which one i want and to go directly to the specialist if i so wish. Get treated ASAP and get back to work, minimal time off work sick.
Contrast that with having to make an appointment to see my PCP, wait for appointment. Request a referral, wait 5-10 days for approval to be approved and then eventually go to the specialist. An additional amount of time spent off work sick while waiting for a procedure.
I'm not saying it is better treatment from medical viewpoint but it is a better treatment in terms of time frame. Getting me well and back to work in less time. But maybe being off work is not a concern for some, maybe even desirable?
Contrast that with having to make an appointment to see my PCP, wait for appointment. Request a referral, wait 5-10 days for approval to be approved and then eventually go to the specialist. An additional amount of time spent off work sick while waiting for a procedure.
I'm not saying it is better treatment from medical viewpoint but it is a better treatment in terms of time frame. Getting me well and back to work in less time. But maybe being off work is not a concern for some, maybe even desirable?
I find who I want, I ring my PCP, he faxes referral to doc/insurance and jobs done.
I've never actually had to go see him for a referral.
So again, it's all got to do with your own insurance plan.
A PPO can be just as crap if they are limited on in-network.
All about the details, rather than which is a better system or not.
Apr 17th 2014, 3:31 pm
#29
WTF?
Joined: Aug 2003
Location: Homeostasis
Posts: 79,367
Re: HMO or PPO?
Hi all!
I did a little searching in the forums but did not get the answers I was really looking for.
It looks like I may be switching companies in the very near future. Right now my medical insurance is through the Union and is more a medical fund, with one big pot everyone pays into. It is a PPO setup so no need for referrals etc. I have never had to pick plans before because of this, My new employer offers two options, a PPO and a HMO. Both are through Cigna it appears. The PPO has a lower monthly premium (only by about $20) but a higher out of pocket maximum ($3700/$7400 vs $2400/$4800). We are looking to hopefully start trying for another baby in the near future so, due to this the HMO seems like it would be the better option? I gather HMO's are far more limiting and this is what has me concerned. I am about to start checking to see if our present doctors accept this HMO plan, if so I will probably go this route. Does anyone have any insight as to the for or against for each?
I hate that this is all so complicated and confusing here!
I did a little searching in the forums but did not get the answers I was really looking for.
It looks like I may be switching companies in the very near future. Right now my medical insurance is through the Union and is more a medical fund, with one big pot everyone pays into. It is a PPO setup so no need for referrals etc. I have never had to pick plans before because of this, My new employer offers two options, a PPO and a HMO. Both are through Cigna it appears. The PPO has a lower monthly premium (only by about $20) but a higher out of pocket maximum ($3700/$7400 vs $2400/$4800). We are looking to hopefully start trying for another baby in the near future so, due to this the HMO seems like it would be the better option? I gather HMO's are far more limiting and this is what has me concerned. I am about to start checking to see if our present doctors accept this HMO plan, if so I will probably go this route. Does anyone have any insight as to the for or against for each?
I hate that this is all so complicated and confusing here!
Basically the states that haven't had a strong managed care (HMO) culture Pre-ACA are not as up-to-speed as some other states. So, somewhere like California or Massachusettes, will have better networks with more participating physicians and hospitals than somewhere like Texas which, up to now, has been resistant to HMOs in general. Hopefully this will change but, since the ACA is so new, the networks are very thin.
Apr 17th 2014, 5:01 pm
#30
Northern Monkey!
Thread Starter
Joined: Feb 2006
Location: Jacksonville, Fl
Posts: 530
Re: HMO or PPO?
The only thing I can add is something my insurance agent told me, this applies in Texas and may apply in Florida.
Basically the states that haven't had a strong managed care (HMO) culture Pre-ACA are not as up-to-speed as some other states. So, somewhere like California or Massachusettes, will have better networks with more participating physicians and hospitals than somewhere like Texas which, up to now, has been resistant to HMOs in general. Hopefully this will change but, since the ACA is so new, the networks are very thin.
Basically the states that haven't had a strong managed care (HMO) culture Pre-ACA are not as up-to-speed as some other states. So, somewhere like California or Massachusettes, will have better networks with more participating physicians and hospitals than somewhere like Texas which, up to now, has been resistant to HMOs in general. Hopefully this will change but, since the ACA is so new, the networks are very thin.
