HMO's and the like..
 

Hi again all!

First a big thanks to everyone, the support is invaluable.

Need to sort out Healthcare now.

On my Wife's plans at work the HMO looks good on paper, just waiting to find out the monthly payments. Whats attracted me is there is no deductables or coninsurance, just copays all either$20 or $30.

PPO's just seem too much of a gamble despite our excellent health as you never know what may happen.

The HMO is through CIGNA..means nothing to me but possibly something to one of you?

Re: HMO's and the like..
 

I have always heard the opposite - "Get a PPO rather than an HMO". I know that with an HMO you will have to get your Dr to refer you if you need a specialist and this is where many HMO's put pressure onto the Dr's to limit the referals.

With most PPO's you can go to who you want when you want without a referral.

Re: HMO's and the like..
 

PPO is better, you won't be tied to your PCP, your local hospital, and will be better if you go travelling across the country and get sick.

HMO's tend to be quite restrictive, especially if you get sick and need specialist care and find out your local hospital isn't a specialist hospital, such as cancer, then your either SOL for quality care or would have to stump for it yourself.

Re: HMO's and the like..
 

HMO is a bit like NHS. You have a primary care doctor, and you can only go to a specialist if they refer you. Your primary care doc will be a GP. Lots of GPs won't see HMO patients, you would have to look at a list. Especially many dentists won't see HMO patients.

PPO - costs a bit more, but you can go and see just about any doct you like within your network (state). You can have an internist as your primary care. Most all doctors see PPO patients. You don't need a referal to go and see a specialist.

Re: HMO's and the like..
 

There is no gamble with a PPO. An HMO means you can only go to a doctor within the network and you need a referral from your primary physician to see a specialist, have surgery you have to be cleared for it by the healthcare carrier.

With a PPO (which I have) the only requirement is to go to a network doctor. I had surgery 4 weeks ago. Never had to have approval by my healthcare provider. Never had to have a referral to see the specialist. A true joy.

Re: HMO's and the like..
 

I agree PPOs are better, but some surgical operations do need advance approval, with some companies, they do at my Blue Cross outfit. it is down to the doctor/hospital to get the approval.

Re: HMO's and the like..
 

That's our healthcare provider -- bluecross/blueshield -- and I had absolutely no problem. I'm aghast at the paid bills I've been receiving and at the moment am debating with my conscience as to report the fraudulent claims made by the specialist.

Re: HMO's and the like..
 

Whoa - careful there fella. Many ppo's have largely regional, not nationwide networks and going out of network will cost you.

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My gf is with cigna and isn't a massive fan. Previously with blue cross/blue shield.
I use the aetna ppo but have never been to a dr so can't comment.

Re: HMO's and the like..
 

true...but with an HMO, you will be local, and it'll be very local..PPO tend to be state wide, and a lot of the blue cross tend to be nationwide cover.

Re: HMO's and the like..
 

I have sort of a hybrid, a PPO but with qualified doctors. Sometimes they call it an HMO, sometimes a PPO.

But I would agree with what is said here--HMOs have become more and more restrictive in the 15 years they've been around, with 'guardians at the gate' answering phone calls in the middle of the night and running you through a gauntlet of questions before they OK you to see a physician. I've also run into problems with HMOs and referrals. For example, our doctor's office couldn't do an x-ray for some reason, so we had to goto a 3rd party shop, but they would accept our HMO so we had to go to a second 3rd party that did. Can get really annoying.

Spend a little more to have a regular doctor and less restrictions.

Re: HMO's and the like..
 

Sorry I'm confused ? Nothing new !

Are we all talking about personal healthcare that you take out on your own or healthcare program through an employer ? Or is it all the same here ?

Re: HMO's and the like..
 

It's through an employer....having to pay for it without the employer subsidising means you'll probably pay a lot more for a lot less coverage...one big suckage to self-employment, or owning a small business.

Re: HMO's and the like..
 

as other posted have stated, I think you have actually got the wrong end of the stick - its HMO's that are crap and PPO's that are good...

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True - blue cross blue shit did their best to try and shaft me on two occasions since the insurance provider was in OR and I live in TN

Re: HMO's and the like..
 

My friend is a self-employed model and has to pay $800 per month for herself and two children for HMO coverage with Blue Cross Blue Shield. She thinks they're dreadful - she's just been to see her obgyn (gynaecologist but that word isn't used here) and had to drive quite some distance for her appt. as she can only go to the doctors on her list; the obgyn is so overworked that she was rushed in and rushed out without being able to have a proper discussion with the dr. about her concerns.

In some States - certainly NJ where we live - many obgyns are leaving to work in other parts of the country. Their insurance fees are astronomical in case they're sued for malpractice, so now there aren't enough to adequately cover patient demand.

Re: HMO's and the like..
 

Our HMO has been ace.

It's offered through Aetna, through wifes work at a Fortune 500 company, at a cost to us of around $150 a month for the family. 10-15 dollar co-pays a visit; her whole pregnancy and delivery cost us the princely sum of around $300-350. All of daughters shots and immunizations no more than that same 10-15 dollars a visit.

The network has been perfectly fine, service has been great thus far.

I can't understand this constant slagging of HMO's - they are not all bad, if you are not generally sick, or are completely american in your outlook of "Ooooh got to go to the best Beverley Hills Doctors all the time". Honestly, how many doctors do you need to choose from? The network we are in is huge and every conceivable type of specialist is on there.

Basically, you have to read read and read again everything about the policy and get the best one for your needs. Just because its a HMO doesn't mean its bad. Similarly, there are some god awful PPO's out there that are a ticket to bankruptcy and high bills. HMO, PPO, High Deductibile plan - matters not, as long as you educate yourself and choose wisely.

Re: HMO's and the like..
 

HMO's pay a flat rate to the GP's per month per patient. Get sick too much or want to go see your gp too many times in one month and you may find "Sorry, we don't have any open appointment's" when your friend with the PPO got in the next day ;) That's not wanting to see a "hollywood" specialist, just wanting access to your Dr.

Re: HMO's and the like..
 

I guess its because we don't go much, we don't notice it. That said, the wifes pregnancy and daughters frequent visits (for being a small kid, basically!) posed no problems whatsoever, no waiting, no fuss, at all. From what I have read here, I do think not all HMO's are created equal, in the same way not all PPO's are either. Seems to me the bigger the company you work for, the better the benefits, no matter which plan you choose.

Re: HMO's and the like..
 

That is true. You can get spectacular HMO's and crappy PPO's. I work for a small company and we have pretty decent PPO coverage for a comparable figure to yours but then again I don't have kids.

Re: HMO's and the like..
 

there good and bad to both...but here's a fun story, friends of the in-laws, husband got cancer, HMO made them go to the local hospital as it was there network hospital, 10 miles away, 15 miles away is a top quality cancer hospital, it's one of the best around new england. He died because they couldn't afford the treatment there, and his doctor did say that going there, he would probably survive. They were on an HMO.

Re: HMO's and the like..
 

Yep - its a joke - there aim is to discharge their responsibilities to you as quickly as possible.
Their responsibilities do not include providing you with the best care - just care, any care, full stop.
Personally I don't know how the desk jockeys who work for these firms can live with themselves though I suppose its easier when your customers are just a number on a piece of paper.

Re: HMO's and the like..
 

It's amount of $$$ that is wasted on paper shuffling that is another scandal. I was visiting a specialist last week: he had no fewer than 12 staff working for him - not counting the out-of-office billing service! From what I could tell, all but 4 or 5 of these staff were paper-chasers/phone-jockeys.

And of course the sole purpose of the insurance companies that these extra staff deal with is to shuffle paper and $$$.

At the same time, health care is becoming less and less adequate, and yet more and more expensive.

There is more than enough money in the system to cover everyone more than adequately, but there is not the political will to do anything that would upset the insurance and drug companies. Too many vested interests for starters.

Re: HMO's and the like..
 

I would be interested to know what kind of health insurance that health insurance workers get :D

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Yep - and I don't think it matters what party are in power - there are way too many people getting fat off this so there is no chance of it changing.

Re: HMO's and the like..
 

I had HMO coverage in 2001, which was the year I was pregnant and gave birth. Turned out to be marvelous! I didn't pay one single penny towards any of my pregnancy, or even after the birth and emergency c-section. I saw the total to be paid, $12,996, but didn't have to pay any of it. The following year I changed to a PPO as my OB/GYN wasn't covered by the HMO anymore. Now I love the PPO at this stage of my life. Can go to a specialist without a referral, gotta love that. :thumbup:

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I always wondered how that worked with a PPO - how do you find one ??
Is it listed on the providers website ??

Re: HMO's and the like..
 

The PPO will give you a website that lets you find your specialist.

We used to have Blue cross . Their website was the biggest pile of shite I have ever seen. I am suprised the pentagon didn't use the same layout to hide all of their classified information so that no one can find it. It would be very very painful to find out any information

Now we are with United Health Care. Their website is a lot better. You can search via name, location and speciality. Works like a charm.

Re: HMO's and the like..
 

Two easy ways to find out - providers' website (ours is company-run), or call the doc's and say you want to see a such-and-such specialist, and they'll recommend someone that you're covered for. :thumbup: The latter is how I've found the specialists I've seen. My doc also recommends them and works well with them, so it's a win-win (not to mention it saves me some leg-work :lol: )

Re: HMO's and the like..
 

Ok, so would the decision perhaps be something like..

I'm hardly ever ill,relatively young and don't have loads of capital - HMO for now.

Bit older, potentially have more illnesses but built up more capital - PPO.

I know that's a generalisation but I'm trying to get it straight in my head.

Re: HMO's and the like..
 

Nope - the options I was given at work they were both the same price - I would say seeing as you mentioned cigna as the hmo to steer clear and go for ppo.

Re: HMO's and the like..
 

It really isn't as simply as that. You have to compare not only the details of the actual plans, but also the location and reputation of the specialists and hospitals included.

For instance, one absolute requirement as far as I am concerned is easy access to an ER, and to have a top-notch cancer hospital in the plan. Emergencies can happen to anyone, and cancer can strike at any age.

What you do not want is a requirement to go to an overburdened community ER for emergency care, or cancer patients having to make do with a non-specialist center.

Re: HMO's and the like..
 

Manc worked for state farm I think, for a while, didn't have any insurance :lol:

Re: HMO's and the like..
 

It's more a case of taking what your employer offers most of the time....but if you get the choice, look at the small print, what the deductibles are, especially for eye balls and teeth, what the co-pays are and % of coverage before they fully cover the cost, it could be 100%, or it could be 80/20 split, 20% on a million dollars of cancer treatment or a heart opp...could you afford that?

Also check what your covered for if/when you have kids such as pre/post natal care...if ambulance fee is included and if there is an overnight stay requirement before they pay...check to see how long they'll pay for you to stay in a hotel...see what happens if your in an accident out of state or out of network.

Look for what preventative care you have, such as physicals, other exams, etc, etc.

Re: HMO's and the like..
 

As everyone has said, it isn't that simple, and sometimes you don't have a choice. That said, if you work for a biggish company, you might well get a choice in plan.

This is one of those areas that to do it justice, you cannot simplify it; and must wade through the small print to make sure you know whats what. I have found this to be the case with everything to do with all insurance in the US; all legal paperwork; all title deeds; all car purchases, all contracts of any kind. It truly seems everyone is out to screw you, and the only way to fight it is to be vigilant and educate yourself by knowing exactly whats what. The nice and simple UK way of doing things does not apply here - you don't particularly have good consumer rights here (if you indeed have any at all), and the system is stacked to prey on the unwary. In fact, a lot of the time, it counts on it - its really great when you turn the tables right on them by quoting small print.

If that sounds like a lot of crap you shouldn't have to deal with - it is, however, having spent the time to really educate myself on everything to do with finance, investment plans, insurance, home ownership etc, I'm certainly glad I did. The more you know the better prepared you are to make good decisions here; and the less money you will end up spending on unneccesary middlemen, bad plans, etc - not just health insurance but pretty much everything.

Re: HMO's and the like..
 

He didn't work in or sell health insurance did he?


NC Penguin