CandaceM23 Posted February 22, 2009 Share Posted February 22, 2009 I was recently laid off from a company that I worked with for 9 years .... Thank goodness I found another job within two weeks of being laid off. I was talking with my new boss yesterday and he showed me a bit of information on their health care plans. It looks like their provider is Blue Cross Blue Shield and I have a choice between an HMO or a PPO. I've never had the option before and I'm relatively clueless when it comes to HMO's. I've always had a PPO and paid the premium to go where ever I wanted. It looks like the cost per paycheck for the HMO is $18. The cost for a PPO per paycheck is $80. I'm really not all that concerned about the cost of the plans ... I'm just worried about the options. I've done a bit of reading on the interwebs about HMO's and they sound incredibly strict. Can anyone tell me of their experiences with a HMO? Good, bad, so so? Link to comment Share on other sites More sharing options...
Thiebear Posted February 22, 2009 Share Posted February 22, 2009 My EPO that i somehow got one year wouldnt let me use my doctor. The next year i was back to the PPO. Any plan is better than none. But when i got the GBS and had to get the treatment. I bet the EPO would have said no, or been horribly expensive. Link to comment Share on other sites More sharing options...
PleaseBlitz Posted February 22, 2009 Share Posted February 22, 2009 HMO's are totally worthless. I started a new job last december and opted to save a few bucks by picking the HMO, Kaiser Permenente. One of the worst decisions ive made in years. I have a chronically bad back, and once every 9 months or so i need to go to physical therapy. I know what needs to be done to me in PT (electric stim), because ive been so many times. Well, instead of going to the one 3 blocks from my place in Arlington that ive been going to for years, now i have to drive to ****ing Springfield, and they close at 5, so i would need to leave work early. The one time i went, i TOLD them what works, and the ****ing lady completely ignored me. I ended up saying ****it and buying my own electric stim machine, which run about $600, thank God for amazon.com. Kaiser Permenente i am convinced doesnt employ any actual doctors, just a ton of nurses and techs. I also need a cyst removed from my neck, which is a minor procedure ive had done before. Under a PPO a dermotologist could remove it with one 20 minute appointment. I went in for my first appointment for this one the first week of december. They still havent removed it, but they've sent me on 4 different tests and wasted about 5 hours of my time and $125 in copays. Dont get an hmo. Link to comment Share on other sites More sharing options...
twa Posted February 22, 2009 Share Posted February 22, 2009 I have always opted for PPO,being able to choose your Dr and hospital (not from some highly restricted list) is worth the extra to me. But you certainly pay for it. I wouldn't allow just anyone to work on my car or house,so I sure don't with medical for my wife or me. Link to comment Share on other sites More sharing options...
chipwhich Posted February 22, 2009 Share Posted February 22, 2009 Candace, I own a company. 16 employees. I offer three tiers of service. HMO is my cheapest tier. Unfortunately I am the benefits person for my company and setup all of the health plans. I can assure you, getting an intelligent answer in this thread will be next to impossible because every companys coverage is different from the next. An employee at company A can have Aetna HMO and company B have Aetna HMO and both plans be totally different. When I set up my BC/BS HMO and PPO plans everything is ala cart. Basic difference in BC/BS is by default the HMO requires a primary care physician (PCP). A PPO does not. Both plans require you to go to a doctor withing the BC/BS network. If you have a PCP, if you want to go to any other doctor in the network, you need your PCP to refer you. (I changed my companys HMO Plan to be HMO Open Access which means my employees, although they have a PCP need no referrals). ALL of my employees selected the HMO option and love it. BC/BS HMO -vs- PPO plan is probably the most transparent to the consumer in the industry. At your age, I would select the HMO. Check to see if your company offers open access. If you have heartburn with having a PCP and no open access, then choose the PPO. Also make sure your doctor participates in the HMO/PPO plans. The main thing to look at for you is the copays. With my company, the copays I could choose for my HMO and PPO plans vary. I could have selected to have the copays on my HMO be $0 and copays on PPO be $50. Or I could reverse that. Or I could make it the same. All options cost me the employer different amounts of money. I could make my HMO be much more cost effective for employees and PPO be much more cost prohibitive...or vise versa. Ignore anyone's posts in this thread regarding HMO's that are not Blue Cross/Blue Shield. Totally different animals. Let me know if you have any further questions. See you "At your moms house" Link to comment Share on other sites More sharing options...
CandaceM23 Posted February 22, 2009 Author Share Posted February 22, 2009 I've never had an HMO. It was either Carefirst's PPO plan or the other option that was offered to me was United Healthcare. I opted for Carefirst because of their coverage. I'm pretty accident prone and have a list of issues that require doctors visits. I decided to pay more for Carefirst because I had FULL coverage, whereas with United Healthcare I would always be responsible for at least 10% of my bill. 10% of a hospital bill is outrageous most of the time ... so it was an easy decision for me. PB - your story about HMO's is scaring me. I had a cyst that popped up in my neck and became infected in a matter of hours .... I was able to go to a doc who recommended that I go immediately to a surgeon and I had the cyst out the next day. I'm convinced that your insurance doesn't want to take your cyst out and they're giving you the run around in hopes that you'll give up on having it taken out. Link to comment Share on other sites More sharing options...
CandaceM23 Posted February 22, 2009 Author Share Posted February 22, 2009 BC/BS HMO -vs- PPO plan is probably the most transparent to the consumer in the industry. At your age, I would select the HMO. Check to see if your company offers open access. If you have heartburn with having a PCP and no open access, then choose the PPO. Also make sure your doctor participates in the HMO/PPO plans. This is the most important thing to me .... I have girl issues and all of the local docs around here that I've been to are kooks. I go to JHH and love it there - and I don't really want to switch doctors at all. But - if they aren't covered under any of the plans, then they aren't covered ..... I'm not worried about copays for the most part. I pay $15 to see my PCP now and $25 for specialists. It's not too bad but some people think that it's expensive. I think that it's worth it because everything is covered under my plan. Link to comment Share on other sites More sharing options...
chipwhich Posted February 22, 2009 Share Posted February 22, 2009 This is the most important thing to me .... I have girl issues and all of the local docs around here that I've been to are kooks. I go to JHH and love it there - and I don't really want to switch doctors at all. But - if they aren't covered under any of the plans, then they aren't covered ..... I'm not worried about copays for the most part. I pay $15 to see my PCP now and $25 for specialists. It's not too bad but some people think that it's expensive. I think that it's worth it because everything is covered under my plan. If your BC/BS HMO doesn't offer the open access feature, and you want to go to any doctor without referral, then choose the PPO. Don't fear the word HMO because of other peoples problems. ALL plans for ALL companys are so different, you really can't listen to anyones personal experience. Setting up a health care plan is a nightmare. Link to comment Share on other sites More sharing options...
MissU28 Posted February 22, 2009 Share Posted February 22, 2009 honestly, I LOVE my HMO. I had never had one before I moved to California, but Kaiser is free, so it was an easy choice. I love efficiency, and efficiency is what you get with an HMO. I see the gyno and the derm at my HMO, and I can go to the same building. If I needed x-rays, blood tests, or anything else, it's all in one building. I love that. The pharmacy is also right there, and much cheaper than going to Walmart or something to pick up prescriptions. Seriously, I love how it is a one-stop shop. Personally, it's not a huge deal to me if I don't have the same doctor all the time. When I decide to have a baby, that will change, but for now, the HMO is perfect. Link to comment Share on other sites More sharing options...
MissU28 Posted February 22, 2009 Share Posted February 22, 2009 Basic difference in BC/BS is by default the HMO requires a primary care physician (PCP). A PPO does not. Both plans require you to go to a doctor withing the BC/BS network. If you have a PCP, if you want to go to any other doctor in the network, you need your PCP to refer you. (I changed my companys HMO Plan to be HMO Open Access which means my employees, although they have a PCP need no referrals). ALL of my employees selected the HMO option and love it. I had to select a PCP but I have never seen him or met him. He is actually in a different building and city than the one I actually go to. You don't have to see him first and he doesn't have to refer you. My gyno was the one that referred me to the derm. Super easy. Link to comment Share on other sites More sharing options...
PleaseBlitz Posted February 23, 2009 Share Posted February 23, 2009 PB - your story about HMO's is scaring me. I had a cyst that popped up in my neck and became infected in a matter of hours .... I was able to go to a doc who recommended that I go immediately to a surgeon and I had the cyst out the next day. I'm convinced that your insurance doesn't want to take your cyst out and they're giving you the run around in hopes that you'll give up on having it taken out. What scares me going in to have it removed this tuesday is that the "doctor" that saw me was NOT sure of herself at all and when i asked some simple questions like "do you know what the **** you are doing?" she gave me some **** and bull story about having been in private practice for YEARS in NYC. Im pretty good at knowing when people are lying, and she definitely was. Like i said, i dont think KP employs any actual MD's. Cant wait until Tuesday. I give it 50/50 that if the same 'doctor' performs the procedure, she nicks my carodid. Link to comment Share on other sites More sharing options...
HOF44 Posted February 23, 2009 Share Posted February 23, 2009 The only experience I have had with HMO's is Kaiser. The best way I can describe them is they have a front line of doctors whose sole job is to turn you away and keep you from costing them anything. If you can get past this front line they have some good doctors and care. My mom had been complaining of itching and went there over and over for about a year, they sent her for allergy tests over and over but nothing came up and thats what they insisted she had. My sister decided to take her to her GP doctor and pay for it ourselves just to try to help. Dr. looked at her and said she looked anemic, which causes itching. To make a long story short after numerous tests it's discovered she has a tumor in her intestine making her anemic. Went back with this info to Kaiser and she got past the front line and was well taken care of. We switched her to a PPO next chance we got. She's doing good now. Link to comment Share on other sites More sharing options...
TMK9973 Posted February 23, 2009 Share Posted February 23, 2009 Where are you located? States have passed a lot of laws in reguards to HMO's. For instance - HMO in MD sucks. But I had a HMO in CA and it was fine. Didn't need to get a refereal first, there were laws covering what tests had to be done and who had final say (Dr or Insurance companies). In CA, we decided to use the HMO to see if it was ok, and 3 years later were still on it. Link to comment Share on other sites More sharing options...
LeesburgSkinFan Posted February 23, 2009 Share Posted February 23, 2009 I have had Aetna's Open Access HMO for 3 years and it has proven to be excellent. No issues whatsoever. Link to comment Share on other sites More sharing options...
TMK9973 Posted February 23, 2009 Share Posted February 23, 2009 I had to select a PCP but I have never seen him or met him. He is actually in a different building and city than the one I actually go to. You don't have to see him first and he doesn't have to refer you. My gyno was the one that referred me to the derm. Super easy. That is due to you being in CA. In other states you have to see your PCP Link to comment Share on other sites More sharing options...
Tulane Skins Fan Posted February 23, 2009 Share Posted February 23, 2009 I had to select a PCP but I have never seen him or met him. He is actually in a different building and city than the one I actually go to. You don't have to see him first and he doesn't have to refer you. My gyno was the one that referred me to the derm. Super easy. HMO's are great when you are healthy. They are terrible if you are sick. Link to comment Share on other sites More sharing options...
mcsluggo Posted February 23, 2009 Share Posted February 23, 2009 I have Kaiser, and have had them both in Nor-CAL and in NOVA, and have mostly been happy with the service. That said, I believe the California service was superior. I have been an INTENSIVE user of the services, as well. the only time I had real problems was when my wife had the bad sense to badly break her arm while we were out of town in an area that didn't have kaiser coverage.... it was a pain in the heiney getting the emergency coverage straightened out. On the other hand... we have had serious complications in the births of my children... my oldest daughter was in intensive care for months after birth and the care was BEYOND REPROACH. Absolutely incredibly outstanding top-notch... and we paid the one co-pay when my wife went into the hospital (the total cost of service for those 2-months was well into the 6-figures). now that we are back in the DC area (we use the falls church Kaiser facility, for the most part), i think the service has slipped some, but still is good. (that said we did go to the springfield facility once when we first got to town.... ONCE, and almost dropped Kaiser on the spot.) Link to comment Share on other sites More sharing options...
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