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HMO's and the like..

HMO's and the like..

Old Feb 5th 2007, 9:41 pm
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Default 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?
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Old Feb 5th 2007, 9:55 pm
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Default Re: HMO's and the like..

Originally Posted by ScottMc View Post
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?
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.
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Old Feb 5th 2007, 10:09 pm
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Default 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.
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Old Feb 5th 2007, 10:15 pm
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Default 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.
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Old Feb 5th 2007, 10:27 pm
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Default 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.


Originally Posted by ScottMc View Post
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?
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Old Feb 5th 2007, 11:39 pm
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Default 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.
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Old Feb 5th 2007, 11:52 pm
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Default Re: HMO's and the like..

Originally Posted by paddingtongreen View Post
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.
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.
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Old Feb 6th 2007, 12:12 am
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Default Re: HMO's and the like..

Originally Posted by Bob View Post
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.
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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Old Feb 6th 2007, 12:13 am
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Default Re: HMO's and the like..

Originally Posted by ScottMc View Post
The HMO is through CIGNA..means nothing to me but possibly something to one of you?
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.
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Old Feb 6th 2007, 12:38 am
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Default Re: HMO's and the like..

Originally Posted by BigDavyG View Post
Whoa - careful there fella. Many ppo's have largely regional, not nationwide networks and going out of network will cost you.
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.
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Old Feb 6th 2007, 2:28 am
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Default 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.
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Old Feb 6th 2007, 3:05 am
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Default 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 ?
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Old Feb 6th 2007, 3:09 am
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Default Re: HMO's and the like..

Originally Posted by Richardowen View Post
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 ?
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.
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Old Feb 6th 2007, 4:12 am
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Default Re: HMO's and the like..

Originally Posted by ScottMc View Post
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?
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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Old Feb 6th 2007, 4:14 am
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Default Re: HMO's and the like..

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