I hate doctors and will avoid one as much as possible. Anyway, which of the two plans would you prefer? I always had PPO because that’s what our company used to offer. This new one I am joining offers HMO stuff too through Kaiser Permanente. The cost for HMO is lower but so are the choices. I don’t know how Kaiser Permanente services are in my area .. so I am leaning towards PPO for now.
Any suggestions?
Re: HMOs vs. PPOs
In HMOs you are 'restricted' to get referrals to see a specialists, in PPOs you just goto any in-network doctors/specialists without prior approvals, thats the only reason I've been choosing PPOs.
Re: HMOs vs. PPOs
Ahmadjee: PPO is the way to go if you want to have a peaceful life:) I hate asking for referrals for every little thing. With PPO, you feel more independent, and select your own doctors. Since, you have a baby in the family also, i would stick with PPO. I know you have to pay a little extra but in the long run it is worth it.
Re: HMOs vs. PPOs
PPO all the way. Say a big NO to HMO, you dont want to get entangled with HMO mess.
Re: HMOs vs. PPOs
AJ, everyone will tell you to go with PPO over HMO, but I have had no complaints with HMO thru Kaiser so far. I guess I may have complaints when/if I get seriously ill. You dont really need to see a specialist for every small ailment.
Re: HMOs vs. PPOs
^ And yet ANOTHER issue you disagree with Republicans. When will you admit you are not really part of the Dark Side?
Re: HMOs vs. PPOs
are u saying that you don’t need referals in HMO if you visit a general (non specialist) physician?
Re: HMOs vs. PPOs
You prolly do when you get seriously ill and the general physician cant handle. I havent had to see a specialist everytime I had to see a doctor. Demanding to see a specialist for every ailment is rather silly.
Re: HMOs vs. PPOs
There is also an EPO plan ... it seems like the scaled down version of a PPO. It's stil expensive than an HMO.
Re: HMOs vs. PPOs
AJ, with kids and a wifey you need PPO. Dont listen to 5abi he is only giving you a single guy perspective...sure I will be going the HMO route if I was single....but with family...no questions asked its PPO.
Re: HMOs vs. PPOs
If you have option of EPO then that is much better IMO, as it provides flexibility of PPO, the only downside is that it doesn't have "out-of-network", and if doctor of your choice is not on network then it could be some issue.
Re: HMOs vs. PPOs
Ok - do you or do you not need a referal in HMO when you visit a general physician? Yes or no? Assume that its just a regular checkup or u just need a prescription for ur allergies and don’t need a specialist.
Re: HMOs vs. PPOs
I just want to say CIGNA sucks!!! Our company switched from BCBS to Cigna and hardly any docs in our area accept Cigna. I hope I never get sick!
Re: HMOs vs. PPOs
In HMO I don't believe you need any referral, unless you are going for a "second opinion" (which I doubt will require a 'referral'). Referral means a general physician 'approving' or 'sending' you to a "specialist".
Re: HMOs vs. PPOs
Thanks. I have always had PPO so I didn’t know how HMO worked. My benefit package includes free PPO coverage thru United health care currently but that might change in the near future I have heard. So I was just being proactive.
Re: HMOs vs. PPOs
Slight correction in my comments, you don’t need a referral to see a “general” physician.
Re: HMOs vs. PPOs
Well for the stubborn ppl that want to stick with HMO, that is fine with me. But, if my child has a problem and needs to see a specialist i would kill to take that baby to a specialist and when it comes to a baby or anyone, there is no such thing as a "silly little ailment". Everything should be checked out just for peace of mind. If you are paying for your insurance, might as well use the benefits.
Re: HMOs vs. PPOs
Jeeze you people.
First, you should never choose a plan based on the convenience of referals. When it comes down to it this is not why you buy Health Insurance. Instead, look at the quality of the physicians and the hospitals in the network. You are also buying coverage. The object here is to protect your family, and to have the highest level of coverage, by the best physicians at the lowest price.
One of the ways to check is to look at a list of participating physicians in your area for that plan. Sample a few resumes of the ones you are most likely to visit. Do the have degrees from prestigious schools? Are the Board certified in their speciality? How about the Hospitals in the network that you are likely to use? Are they well rated? Any scandals? Recent turnover of exeuctive management?
Back in Jan I had a Stent installed. I researched the procedure, I researched the Doc, I researched the products they would be using, and I researched the Cath lab. That is what you are buying when you buy insurance, access to the best healthcare. DO NOT make a decision based on paperwork or referals, if there is a sacrifice in care.
Re: HMOs vs. PPOs
Ohioguy, we are "employees", so most of us dont' get luxury of picking up 'brand' (insurance company), all we get to choose is PPO, EPO or HMO. In most cases, PPO and EPO carry same doctors in network. HMO is a different case. I tend to rely on insurance company for that kinda homework (check physician/specialist's qualification/experience "black history").
When insurance companies changed (employer switching between insurances or me changing job) I did try to see if the doctors I've had satisfactory results with are covered or not.
Now that I'm trying to find a insurance company on my own I guess I'll have to do what you suggested above. The insurance company offered by my current employer is very sucky (limited sickness/accident insurance) and I had a bad experience with a doctor so now I'll have to be careful about the insurance company (qualifications/experience of doctors in their network).
Re: HMOs vs. PPOs
and to add what captain said, most, if not all, doctors are in the network with PPO.