GeoffM

Our new health insurance has taken three months to find a specialist for DS (autism), and we've now been told he has a three month waiting list. I don't remember waiting 6 months on the NHS! Basically we've been told if we want one sooner then we (a) have to pay out-of-network costs; and (b) travel to get it.

I've come to learn that our new health insurance really is shit in multiple ways. For the first 2.5 years on Kaiser P I wondered what all the fuss was about. Now I'm learning!

hungryhorace

Kaiser is usually very good from everything I read. Apart from the requirement you go to their hospital, if memory serves.

Who is your new insurance with? Here in MA from everything I've experienced, all the specialists / hospitals I've visited take our insurance (#2 most popular behind BCBS).

My (brief) experience on the NHS was a waiting period of months - my mum has been waiting for an operations for years btw - which meant I just went through my private insurance each time. Always bugged me that those with private insurance didn't get a rebate on their tax return.

GeoffM

Yes - the main issue, even if we could have it here, is that their nearest hospital is about an hour away. There is a doctor's office, pharmacy, and urgent care here but anything more than family medicine would involve travelling an hour.

I don't fully understand the ins and outs of it but it appears to be Prime Healthcare EPO (some form of PPO), backed up by Anthem Blue Cross. The hospital the wife works at is big enough but I think the group itself is not so, so we're limited in availability of specialists etc.

Bob

Well you wouldn't because you're still using NHS facilities...and if you needed long term treatment, chances are the insurance wouldn't treat you, but host you in their private rooms...it is a good bargain though and a nice work benefit usually and nice that you're not dropped in the lurch mid-treatment if you got laid off.

Jerseygirl

He's got a valid point though...

Michael

EPO stands for "Exclusive Provider Organization" plan. As a member of an EPO, you can use the doctors and hospitals within the EPO network, but cannot go outside the network for care. There are no out-of-network benefits.

EPOs, though cost effective, are quite restrictive since the network of doctors is usually smaller than in HMOs and it is nearly impossible to see an out-of-network provider without paying the entire medical fees from one's own pocket