Englishmum

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.

Dan725

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.

dan_alford

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.

Dan725

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.

dan_alford

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.

Bob

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.

BigDavyG

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.

Elvira

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.

dan_alford

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

BigDavyG

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.

Maz

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.

BigDavyG

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

dan_alford

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.

Maz

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. 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 )

ScottMc

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.