HMO vs PPO

[Yax]

Originally posted by: PingSpike

Originally posted by: cheapbidder01
HMO is only good till you have an emergency. Then you'll have to wait till you get a hold of your doctor and get his opinion before going to the emergency room or risk the chance of paying for the visit yourself. With PPO, you get to make the decision whether or not its an emergency and you'd be covered no matter what.

So you just have to ask yourself, am I smart enough to determine when I need emergency care?

Answer:
Yes = PPO
NO = HMO.

😉

Its cheaper with HMO because in times of emergencies, ( the more costly times) you may end up paying for it yourself. That's the risk you take.

Seeing how my dermatologist allows me to get referals from my primary care doctor after I have visited her, I don't think I would likely have to wait on the way into an ER. But your plan may be different.

With HMO, you're supposed to get referral before seeing the dermatologist. And what happens when your HMO doctor says he can't give you that referral?

Its the same with emergencies. If you feel you have an emergency and go in. Then your doctor determines that it was not an emergency, the cost is on you.

 

[HeroOfPellinor]

Originally posted by: PingSpike

Originally posted by: spidey07

Originally posted by: PingSpike

Originally posted by: HeroOfPellinor
The whole point of health insurance, for me, is the max yearly deductible. PPOs, generally, have co-pays for hospitalization of 20% which can easily become an astonomical figure.

Affirmative. PPO are handy if you want to pick and choose your doctos, but that 80% crap is likely to leave you pretty screwed if something serious happens to you. PPO would be ideal even with that deductable if it covered 100%. Assuming it does not, get the HMO. 20% of a whole freaking lot of money is still a whole freaking lot of money.

that's what the out of pocket maximum is for. You can't go over a certain amount per year no matter what.

Huh, did not know that. What are standard out of pocket maximum rates?

Ditto...I thought only HMOs had maximums. *shrug* Would love to hear more, PS.

 

[PingSpike]

Originally posted by: cheapbidder01

Originally posted by: PingSpike

Originally posted by: cheapbidder01
HMO is only good till you have an emergency. Then you'll have to wait till you get a hold of your doctor and get his opinion before going to the emergency room or risk the chance of paying for the visit yourself. With PPO, you get to make the decision whether or not its an emergency and you'd be covered no matter what.

So you just have to ask yourself, am I smart enough to determine when I need emergency care?

Answer:
Yes = PPO
NO = HMO.

😉

Its cheaper with HMO because in times of emergencies, ( the more costly times) you may end up paying for it yourself. That's the risk you take.

Seeing how my dermatologist allows me to get referals from my primary care doctor after I have visited her, I don't think I would likely have to wait on the way into an ER. But your plan may be different.

With HMO, you're supposed to get referral before seeing the dermatologist. And what happens when your HMO doctor says he can't give you that referral?

Its the same with emergencies. If you feel you have an emergency and go in. Then your doctor determines that it was not an emergency, the cost is on you.

All I know is I just went to my dermatologist without speaking to my primary care or his office and a few phone calls later I got a retroactive referal. I would tend to think if that worked with something trivial like some zit medicine that it would work with an ER. I highly doubt that they have to call your doctor and ask him 20 questions my heart isn't working. But hey, thats just how it works for me.

 

[HeroOfPellinor]

Originally posted by: cheapbidder01

Originally posted by: PingSpike

Originally posted by: cheapbidder01
HMO is only good till you have an emergency. Then you'll have to wait till you get a hold of your doctor and get his opinion before going to the emergency room or risk the chance of paying for the visit yourself. With PPO, you get to make the decision whether or not its an emergency and you'd be covered no matter what.

So you just have to ask yourself, am I smart enough to determine when I need emergency care?

Answer:
Yes = PPO
NO = HMO.

😉

Its cheaper with HMO because in times of emergencies, ( the more costly times) you may end up paying for it yourself. That's the risk you take.

Seeing how my dermatologist allows me to get referals from my primary care doctor after I have visited her, I don't think I would likely have to wait on the way into an ER. But your plan may be different.

With HMO, you're supposed to get referral before seeing the dermatologist. And what happens when your HMO doctor says he can't give you that referral?

Its the same with emergencies. If you feel you have an emergency and go in. Then your doctor determines that it was not an emergency, the cost is on you.

:roll:

Emergencies are excluded...it has a separate group of deductibles and co-pays. And if your PCP doesn't think you need to go to a dermotologist then you probably don't. Never heard of anybody being denied though.

 

[Yax]

Originally posted by: HeroOfPellinor

Originally posted by: cheapbidder01

Originally posted by: PingSpike

Originally posted by: cheapbidder01
HMO is only good till you have an emergency. Then you'll have to wait till you get a hold of your doctor and get his opinion before going to the emergency room or risk the chance of paying for the visit yourself. With PPO, you get to make the decision whether or not its an emergency and you'd be covered no matter what.

So you just have to ask yourself, am I smart enough to determine when I need emergency care?

Answer:
Yes = PPO
NO = HMO.

😉

Its cheaper with HMO because in times of emergencies, ( the more costly times) you may end up paying for it yourself. That's the risk you take.

Seeing how my dermatologist allows me to get referals from my primary care doctor after I have visited her, I don't think I would likely have to wait on the way into an ER. But your plan may be different.

With HMO, you're supposed to get referral before seeing the dermatologist. And what happens when your HMO doctor says he can't give you that referral?

Its the same with emergencies. If you feel you have an emergency and go in. Then your doctor determines that it was not an emergency, the cost is on you.

:roll:

Emergencies are excluded...it has a separate group of deductibles and co-pays. And if your PCP doesn't think you need to go to a dermotologist then you probably don't. Never heard of anybody being denied though.

Also, you need to see which emergency hospital is covered by your HMO too, you can't just walk into any.

 

[spidey07]

Originally posted by: HeroOfPellinor

Originally posted by: PingSpike

Originally posted by: spidey07

Originally posted by: PingSpike

Originally posted by: HeroOfPellinor
The whole point of health insurance, for me, is the max yearly deductible. PPOs, generally, have co-pays for hospitalization of 20% which can easily become an astonomical figure.

Affirmative. PPO are handy if you want to pick and choose your doctos, but that 80% crap is likely to leave you pretty screwed if something serious happens to you. PPO would be ideal even with that deductable if it covered 100%. Assuming it does not, get the HMO. 20% of a whole freaking lot of money is still a whole freaking lot of money.

that's what the out of pocket maximum is for. You can't go over a certain amount per year no matter what.

Huh, did not know that. What are standard out of pocket maximum rates?

Ditto...I thought only HMOs had maximums. *shrug* Would love to hear more, PS.

My max is 2000 out of pocket.

For example this year I had some back problems. I was able to go to the best physical therapist in town for a paltry 20 bucks. Checking on my bills each visit was actually around 500 bucks but I only had 20 dollar co-pay.

I went about 20 times. With an HMO I would be stuck at some doc-in-a-box saying "here, just take advil"

I guess the point I'm trying to make is with a PPO you have freedom and choice to go to whatever doctor you wish.

And don't forget...those co-pays are deductible.
😉

 

[HeroOfPellinor]

Originally posted by: cheapbidder01
Also, you need to see which emergency hospital is covered by your HMO too, you can't just walk into any.

Yeah, that's way too much work to do.

 

[Yax]

Originally posted by: HeroOfPellinor

Originally posted by: cheapbidder01
Also, you need to see which emergency hospital is covered by your HMO too, you can't just walk into any.

Yeah, that's way too much work to do.

I recall when I last tried HMO (I've tried it twice and both times were disasters), my daughter, who was about 4, had horrible stomach pains. She couldn't walk and was lying in bed. We paged the doctor, but go no response. We had to take her to the clinic. The one near us was not with our HMO. The one we needed to go to was all the way across town.

Finally, we get there, had her checked out and the doctor said it was GAS! The doctor even said bad GAS can kill small children.

Well, since it was determined that GAS was not considered an emergency, and we ended up paying for the visit.

After that, no more HMO's for me.

I guess its good if you're the only one covered, but if you have small children and you worry about them, just get PPO. You get what you pay for.

 

[sillymofo]

I'll be the one to dig this thread up... since I was about to "repost".

I looked at the pros and cons of HMO vs PPO, and these are the Blue Shield plans that my company is providing. You decide, all figures are for individual.

Blue Shield PPO (monthly cost: $115.39)

• Life time max benefits: $6mil

• Calender Year Deductible: $250

• Annual Max out of pocket: $2000/ $5000

• Inpatient Hospital: 90%/ 70%

• Doctor's Office Visit: $10 copay/ 70%

• Lab and X-ray: $10 copay/ 70%

• Chiropratic/Accupunture: $25 copay 12/20 visits/yr

• Outpatient Surgery: 90%/ 70%

• Emergency room: $75 copay waived if admitted then covered at 90%/ 70%

• Prescription drugs: Generic-$10, Formulary Brand Name-$20, Non-Formulary Brand Name-$35, Mail Order-$20/$40/$60 for 1/2/3 months supply

Blue Shield HMO (monthly cost: $9.08 - NOT A MISPRINT)

• Life time max benefits: Unlimited

• Calender Year Deductible: None

• Annual Max out of pocket: $1000

• Inpatient Hospital: 100%

• Doctor's Office Visit: $10 copay/ 70%

• Lab and X-ray: $10 copay

• Chiropratic/Accupunture: Not covered (how often do you visit an accupunture office anyway?)

• Outpatient Surgery: $50 copay

• Emergency room: $50 copay

• Prescription drugs: Generic-$10, Formulary Brand Name-$20, Non-Formulary Brand Name-$35, Mail Order-$20/$40/$60 for 1/2/3 months supply

There you have it. Now, most of the doctors within BlueShield PPOs are also in their HMO's network, so out goes the window your argument of "I get better doctors". Quit watching Hollywood movies, and listening to dumbasses that can't take care of themselves and blame HMOs.

 

[FoBoT]

it depends

good luck

 

[CtK]

i chose HMO so im gonna stick with it 🙂

 

[spidey07]

Originally posted by: cr4zymofo
I'll be the one to dig this thread up... since I was about to "repost".

I looked at the pros and cons of HMO vs PPO, and these are the Blue Shield plans that my company is providing. You decide, all figures are for individual.

Blue Shield PPO (monthly cost: $115.39)

• Life time max benefits: $6mil

• Calender Year Deductible: $250

• Annual Max out of pocket: $2000/ $5000

• Inpatient Hospital: 90%/ 70%

• Doctor's Office Visit: $10 copay/ 70%

• Lab and X-ray: $10 copay/ 70%

• Chiropratic/Accupunture: $25 copay 12/20 visits/yr

• Outpatient Surgery: 90%/ 70%

• Emergency room: $75 copay waived if admitted then covered at 90%/ 70%

• Prescription drugs: Generic-$10, Formulary Brand Name-$20, Non-Formulary Brand Name-$35, Mail Order-$20/$40/$60 for 1/2/3 months supply

Blue Shield HMO (monthly cost: $9.08 - NOT A MISPRINT)

• Life time max benefits: Unlimited

• Calender Year Deductible: None

• Annual Max out of pocket: $1000

• Inpatient Hospital: 100%

• Doctor's Office Visit: $10 copay/ 70%

• Lab and X-ray: $10 copay

• Chiropratic/Accupunture: Not covered (how often do you visit an accupunture office anyway?)

• Outpatient Surgery: $50 copay

• Emergency room: $50 copay

• Prescription drugs: Generic-$10, Formulary Brand Name-$20, Non-Formulary Brand Name-$35, Mail Order-$20/$40/$60 for 1/2/3 months supply

There you have it. Now, most of the doctors within BlueShield PPOs are also in their HMO's network, so out goes the window your argument of "I get better doctors". Quit watching Hollywood movies, and listening to dumbasses that can't take care of themselves and blame HMOs.

meh, talk to health care professionals and their view on HMOs. Like doctors, nurses, specialists.