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Does anyone have Blue Cross Blue Shield HMO?

manlymatt83

Lifer
Oct 14, 2005
10,014
27
91
If so, how do you like it?

I have a PPO now and its really nice, but if I take a new job, I'll be dropping down to an HMO at BCBS... its apparently their "higher plan" one.

-Matt
 

moshquerade

No Lifer
Nov 1, 2001
61,716
10
56
Originally posted by: mjuszczak
<div class="FTQUOTE"><begin quote>Originally posted by: Platypus
Stay far away from the HMO.</end quote></div>


Why?
alright, i just thought of something funny. ;) :laugh:
 

Platypus

Lifer
Apr 26, 2001
31,056
321
136
Originally posted by: mjuszczak
Originally posted by: Platypus
Stay far away from the HMO.

Why?
Knowing you and your frequent doctor visits, you will be incredibly restricted as far as who you can go see now. Most HMO's make you see your primary care doctor regardless of what's wrong first and get a referral from him to a specialist. It's a giant pain in the ass.
 

moshquerade

No Lifer
Nov 1, 2001
61,716
10
56
Originally posted by: Platypus
<div class="FTQUOTE"><begin quote>Originally posted by: moshquerade
<div class="FTQUOTE"><begin quote>Originally posted by: mjuszczak
<div class="FTQUOTE"><begin quote>Originally posted by: Platypus
Stay far away from the HMO.</end quote></div>


Why?</end quote></div>

alright, i just thought of something funny. ;) :laugh:</end quote></div>

I was hoping someone would catch that :D
:thumbsup:
 

manlymatt83

Lifer
Oct 14, 2005
10,014
27
91
Originally posted by: Platypus
<div class="FTQUOTE"><begin quote>Originally posted by: mjuszczak
<div class="FTQUOTE"><begin quote>Originally posted by: Platypus
Stay far away from the HMO.</end quote></div>


Why?</end quote></div>

Knowing you and your frequent doctor visits, you will be incredibly restricted as far as who you can go see now. Most HMO's make you see your primary care doctor regardless of what's wrong first and get a referral from him to a specialist. It's a giant pain in the ass.

Yeah, even though this new job is really nice, I'm beginning to think its a deal killer that they have an HMO only.
 

slsmnaz

Diamond Member
Mar 13, 2005
4,020
0
0
Originally posted by: Platypus
<div class="FTQUOTE"><begin quote>Originally posted by: mjuszczak
<div class="FTQUOTE"><begin quote>Originally posted by: Platypus
Stay far away from the HMO.</end quote></div>


Why?</end quote></div>

Knowing you and your frequent doctor visits, you will be incredibly restricted as far as who you can go see now. Most HMO's make you see your primary care doctor regardless of what's wrong first and get a referral from him to a specialist. It's a giant pain in the ass.
It's not that difficult if you get to know your doctor. I have had no issues calling him on the phone and requesting a referral to a specialist. Many of the referrals are good for a certain amount of time and not per visit. I have nothing but good things to say about how I've been treated by my HMO (but it's Cigna, not BCBS).
 

xochi

Senior member
Jan 18, 2000
891
6
81

I've had Blue Cross/Shield HMO for about four years (Texas). Its a good plan and i have never had any issues. My wife had our youngest child, and my other kids have had ear tubes and a tonscilectomy.

I spoke to our insurance rep a few weeks ago and she said that will no longer write HMO plans only PPO. I'm not to sure why.
 

mattpegher

Platinum Member
Jun 18, 2006
2,207
0
71
Just remember you or your employer are paying less for an HMO than a PPO or traditional plan for a reason. You agree to restriction with an HMO. You need to thoroughly read the plans requirements and regulations as you could find yourself in a position in which it is very difficult to have your care paid for without major headaches.

I had a patient that was visiting from florida and needed to get an ultrasound done in order to determine if the pain that he was having was from his gallbladder. His HMO told me in order to get approval for the study he would have to fly back to florida to get a referral from his primary, his primary would not give the referral without seeing him, and his pain was not severe enough that he wished to go to the emergency department. In the end, he had to go through the ED, incurring another doctors charge, and the study suggested a gallbladder stone. Since it was not acutely infected, an immediate cholecystectomy was not warrented and would not have been paid for. We could not get his Gallbladder removed without sending him back to florida. Needless to say I was not participating with his HMO, he paid cash for my services but the $100 for my visit was nothing compared to the ER visit and the $1000+ for labs and US.

First thing you should ask is if the CEO has the same HMO policy. Most companies give their officers better premium health coverage and give the employees a discount policy.
 

Old Hippie

Diamond Member
Oct 8, 2005
6,361
1
0
My retirement insurance is a BCBS PPO plan. I wondered what the difference was between a PPO and HMO. You fellows have cleared the air.
 

manlymatt83

Lifer
Oct 14, 2005
10,014
27
91
Turns out the HMO they offer is crap. The job sounds SO GOOD too ... nice salary, good plan, etc... but its a blue cross blue shield HMO, I have to choose a prmiary, I can't go out of state, referrals are needed, ugh!! it jsut sucks.

$500 hospital deduction per visit!

I have till tomorrow to decide.
 

geckojohn

Diamond Member
Nov 28, 2000
4,679
0
0
Sometimes HMO plans are better for certain people. The good things about HMO plan is that the costs and co-pays are more predictible.

PPO plans generally have higher co-pays and higher deductible. Each plan and each person is different. There are pros and cons for each type of health insurance plan.
 

manlymatt83

Lifer
Oct 14, 2005
10,014
27
91
Yeah, but this HMO plan is actually MUCH more epxensive than my PPO

Co pay for medicine - $25/$50
Hospital deductible - $500
ER copay - $50
Doctor copay - $20

blah!

This really might be a deal killer. I REALLY want this job, but the h
 

thepd7

Diamond Member
Jan 2, 2005
9,431
0
0
You are going to let health insurance keep you from a great job? If you like it that much pay on the side for your own and opt out of the companies.
 

Gibson486

Lifer
Aug 9, 2000
18,379
1
0
Originally posted by: mjuszczak
Originally posted by: Platypus
<div class="FTQUOTE"><begin quote>Originally posted by: mjuszczak
<div class="FTQUOTE"><begin quote>Originally posted by: Platypus
Stay far away from the HMO.</end quote></div>


Why?</end quote></div>

Knowing you and your frequent doctor visits, you will be incredibly restricted as far as who you can go see now. Most HMO's make you see your primary care doctor regardless of what's wrong first and get a referral from him to a specialist. It's a giant pain in the ass.

Yeah, even though this new job is really nice, I'm beginning to think its a deal killer that they have an HMO only.
it's not that bad. All you have to is call and ask what person your doctor recommends. When I had BCBS, all I had to do was just tell my doctor over the phone that I did this and this. It took 3 seonds of my time.
 

Phokus

Lifer
Nov 20, 1999
23,003
770
126
Originally posted by: mattpegher
Just remember you or your employer are paying less for an HMO than a PPO or traditional plan for a reason. You agree to restriction with an HMO. You need to thoroughly read the plans requirements and regulations as you could find yourself in a position in which it is very difficult to have your care paid for without major headaches.

I had a patient that was visiting from florida and needed to get an ultrasound done in order to determine if the pain that he was having was from his gallbladder. His HMO told me in order to get approval for the study he would have to fly back to florida to get a referral from his primary, his primary would not give the referral without seeing him, and his pain was not severe enough that he wished to go to the emergency department. In the end, he had to go through the ED, incurring another doctors charge, and the study suggested a gallbladder stone. Since it was not acutely infected, an immediate cholecystectomy was not warrented and would not have been paid for. We could not get his Gallbladder removed without sending him back to florida. Needless to say I was not participating with his HMO, he paid cash for my services but the $100 for my visit was nothing compared to the ER visit and the $1000+ for labs and US.

First thing you should ask is if the CEO has the same HMO policy. Most companies give their officers better premium health coverage and give the employees a discount policy.
That's pathetic. We need a new system. The amount of overhead is just so wasteful.
 

manlymatt83

Lifer
Oct 14, 2005
10,014
27
91
Originally posted by: Gibson486
Originally posted by: mjuszczak
Originally posted by: Platypus
<div class="FTQUOTE"><begin quote>Originally posted by: mjuszczak
<div class="FTQUOTE"><begin quote>Originally posted by: Platypus
Stay far away from the HMO.</end quote></div>


Why?</end quote></div>

Knowing you and your frequent doctor visits, you will be incredibly restricted as far as who you can go see now. Most HMO's make you see your primary care doctor regardless of what's wrong first and get a referral from him to a specialist. It's a giant pain in the ass.

Yeah, even though this new job is really nice, I'm beginning to think its a deal killer that they have an HMO only.
it's not that bad. All you have to is call and ask what person your doctor recommends. When I had BCBS, all I had to do was just tell my doctor over the phone that I did this and this. It took 3 seonds of my time.
You weren't in mass though, right?
 

Gibson486

Lifer
Aug 9, 2000
18,379
1
0
Originally posted by: mjuszczak
Yeah, but this HMO plan is actually MUCH more epxensive than my PPO

Co pay for medicine - $25/$50
Hospital deductible - $500
ER copay - $50
Doctor copay - $20

blah!

This really might be a deal killer. I REALLY want this job, but the h
That's actually normal for any insurance. if you were paying $5 copays, then you must had limited health insurance.

 

Gibson486

Lifer
Aug 9, 2000
18,379
1
0
Originally posted by: mjuszczak
Originally posted by: Gibson486
Originally posted by: mjuszczak
Originally posted by: Platypus
<div class="FTQUOTE"><begin quote>Originally posted by: mjuszczak
<div class="FTQUOTE"><begin quote>Originally posted by: Platypus
Stay far away from the HMO.</end quote></div>


Why?</end quote></div>

Knowing you and your frequent doctor visits, you will be incredibly restricted as far as who you can go see now. Most HMO's make you see your primary care doctor regardless of what's wrong first and get a referral from him to a specialist. It's a giant pain in the ass.

Yeah, even though this new job is really nice, I'm beginning to think its a deal killer that they have an HMO only.
it's not that bad. All you have to is call and ask what person your doctor recommends. When I had BCBS, all I had to do was just tell my doctor over the phone that I did this and this. It took 3 seonds of my time.
You weren't in mass though, right?
I was. It was Blue Cross Blue Shield through raytheon.

 

senseamp

Lifer
Feb 5, 2006
34,859
4,801
126
I have BCBS PPO, not HMO, and it sucks. It's much much worse than United Healthcare I had before. They have doctors who never see you overruling your doctor's decisions as to what is necessary. Plus they drag their feet on the payments, I was getting letters that they didn't receive this or that so they won't pay, pretty much nitpicking. One time they were complaining that the hospital sent them the medical records electronically instead of in paper form, so they were refusing to pay for a test. Yep, this is in 21st century.
 

Squisher

Lifer
Aug 17, 2000
21,207
65
91
I have Blue Care Network an HBO thorough BCBS, the only hassles are referrals, but with the relationship I have with my doctor, I call and explain the situation and ask for a referral and that's all it usually takes.
 

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