More to discuss: HMO v. PPO

MinM

I have a PPO. I was telling CW about all of my bills. She was telling me I should go with a HMO next year, because all of her procedures have only cost her $100 each (this includes the birth of her children).

She said with a HMO, she only paid at one office visit for all of her PG related visits.

It sounds like the co-pay for dr's visits are higher with a HMO, but you pay less frequently. Also, I know you have to wait for referals and go to specifc doctors when you have a HMO.

I'd would have to make sure Dr. HS and my OB/GYN take HMOs before I would switch.

Usually people talk about HMOs like they are The Debil. CW thinks it is awsome.

baconsmom

Do you have the option for an HSA? Not the FSA - the regular Health Savings Account. 

We have an HSA PPO, and it's awesome. We don't need referrals for specialists; we pay whatever insurance won't cover from the savings account; we don't have to spend down the account at the end of the year; and we can buy all sorts of OTC stuff from it, as well. Contributions to the account come out before taxes, so it's keeping more of your own money, too, and that money's always there. 

*Barbie*

i had an HMO, and was forced to take a PPO this year. I would LOVE to have my HMO back. yes, there's more freedom with the PPO, but the cost is sooo much higher, and I never had issues finding a doctor in my HMO. 

My ER visit in June would have cost $100 for the HMO - so far I've paid about $350 with the PPO. 

hmonkey

this hmo has a ppo and i would never go back.  the costs are higher, but i do not need referrals and i get to pick my drs.

but more than anything -- it's all about the fsa.  i love it.

MinM

Yes, Barbie - My ER visits are at least $250.

I'm curious how much less my MRI would have cost. That sucker was expensive.

I don't think we have an option for a HSA. Just the FSA, and I never bother with that.

zsazsa-stl

If the HMO includes your doctors, then it is probably fine.  They get a bad rap because of all the times that people in HMOs haven't been able to go to the doctor they wanted.  And even if the summary info tells you that an HMO will cover 90% of the price of a lab test while the PPO only covers 80%, the HMO might end up excluding certain tests that you will have to pay for out of pocket that the PPO would have covered at 80%, etc.  It is next to impossible to tell which plan is better without asking 1,0001 very specific questions from a worthwhile rep at the insurance company.

TheDuckis

Do NOT take an HMO. They require a primary care physician to refer all specialist appointments. Most PCPs then require an office visit to get a referral, so you're paying your copay at the PCP and then another copay at the specialist's. Also their lists of in network doctors are typically much smaller, and they require you to get treatment in one geographic area (if you break your leg on vacation, you have to fly home before it can get treated). My parents had an HMO and when I got sick in college it was a nightmare. I've never heard anything good about anyone with an HMO who actually needed treatment for something.

nicoleg1982

"She said with a HMO, she only paid at one office visit for all of her PG related visits."  --- This was true of my PPO - $600 for all prenatal and birthing care.  I think the hospital bill was my deductible ($2k).

Not too shabby - when I totaled all of the baby expenses billed to the insurance co., it totaled ~$23k.

I would never go back on an HMO for the PPO.  Ever.

MinM

Yeah....Dr. HS doesn't even have a FAX machine. Getting referals out of him would be a PITA.

~~Busy.~~

I have an HMO but since I'm in NYC I've never had problems finding a doctor.  There's one on every other block.  Birthing both my children, all pregnancy related visits and well care visits were FREE.

I've had no issues and am very happy. 

MinM

That would be total ballsacks.

zsazsa-stl

For as often as you find yourself at the doctor, you should do the FSA.  Even if you only put $500 in it, that is $500 tax free dollars.  For mine I get a little credit card and for a lot of places (like CVS) that are following IRS rules you don't even have to send in the receipts.  But it does get to be a pain at times for everything else.  A lot of doctor's officees still look at you like you are crazy when you explain that you need more than just a credit card receipt or a handwritten piece of paper that says "paid."   We put $3,000 in our FSA account this year and there is only about $500 left.  Ugh.

MinM

zsa - I never thought I would be at the doctor this much. All of these things have come clear out of left field. I feel like I'm healthy - I look like it, too - but my body hates me.

*Barbie*

Dec 2009 (under HMO) i went to ER with severe abdominal pain/swelling/etc. - I was there for 12ish hours (overnight), had blood and urine tests, x-rays, CT scans, ultrasounds, was pumped full of drugs and IVs, etc. Did not have to call for referral (b/c it was an emergency and after hours - but did let my PCP office know the next day in case anything was requested on their end.) Total cost for EVERYTHING = $100 co-pay. 

June 2010 (under PPO) I went to ER with extreme nausea, vomiting, pain, dehydration, chills, etc. (was pregnant and OOT - suspected food poisoning or flu). had blood and urine tests. they sent in a nurse with a handheld doppler and checked for a heartbeat. they gave me some medicine and IVs. Total cost to date is $350.

if you have a good PCP, they never require an office visit to see a specialist, they just enter the referral. I never had any issues getting one. 

baconsmom

We've never had to turn in receipts for the HSA, either, though I keep mine just in case - but just the regular credit card slips and stuff. IRS hasn't asked, but I think we've never hit the "send your receipts" threshold, either. 

TheDuckis

We have the HSA, too. If you do it right you can treat it like a retirement account.

My only complaint is that a lot of my doctors don't take credit cards, which means I can't use the debit account and I have to send in receipts. I'm not organized enough for that.

GBCK

I had an HMO I loved...
but they only let me see any doctor/go to any hospital w/i a certain readius of where I work.

I had to drive an hour+ to have surgery and stay in THAT hospital--which was great but, HELL, an hour for the Mr. to drive to visit me?
No way w/ kids.

Cant_wait!

I have an HMO and I love it. My copay is so minimal I don't mind paying to see my GCP to get a referral, but he'll give them over the phone too, which means I don't have to pay for it. Also, my prescriptions are ridiculously cheap, there's no copay at all for ladyparts stuff (includes all pregnancy checks and birthing children).
It helps that my GCP that I've used since I was 7 and my gyn were on "the list".

Heffalump

We only have the PPO option here.  It's not bad.

Paulo's Menina Bela

First thought: Who is PPO and what does she have against Hmo?

<----Need more sleep.

alikatt17

We have an HMO.  The PPO costs an extra $200/month plus it only covers 80% and there's a $2000 deductible per person.  There's so many doctors in the HMO, I don't care.  It's worth that $6400/year minimum savings. 

6fsn

It's hard to just compare HMO v PPO when you start talking deductibles and exactly what each plan covers.  I loved my PPO.

The new company has 3 options- two different HSAs and a PPO.  I really need to figure out which is best, but I'm leaning toward the HSA.  They also have 2 options for dental.  Sooooo many decisions!