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OT: PPO or HMO's what would you choose if you had a choice?


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We are trying to figure out what insurance to go with--we have an option of PPO or HMO. We have always been with PPO's.

Our insurance now is ok. We don't have a co-pay...so what ever the bill is we have to pay until we met our deductible--which is high. We don't go to the Dr. that much, but ds has to go to the cardiologist every 2yrs...so we have to pay around $800 out of pocket every year, just for the visit and we still haven't met his deductible.

 

We already have to find a doctor that is on our PPO network, but they are close to us. If we choose HMO we will have to travel a little further about 20 to 25miles.

 

There will be a $20 to $40 co-pay with the HMO and the insurance agent told us that will be all that we pay:confused: This is something that I am not use to..always use to having a bill in about 2wks come in the mail.

 

Our deductible will be significantly less with the HMO than with the PPO

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We had bad experiences with the HMO's we have been with so we now have a PPO and love it. We put money aside for the deductible - we use our Flexible Spending Account for that. I like having more choices for doctors and not having a gate-keeper trying to get us to use less services. I would never have found my doctor for my thyroid problem if I had to go to the endo specified by the HMO. She told me that my problems were all in my head and I needed antidepressants (they were a disaster.)

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We had bad experiences with the HMO's we have been with so we now have a PPO and love it. We put money aside for the deductible - we use our Flexible Spending Account for that. I like having more choices for doctors and not having a gate-keeper trying to get us to use less services. I would never have found my doctor for my thyroid problem if I had to go to the endo specified by the HMO. She told me that my problems were all in my head and I needed antidepressants (they were a disaster.)

 

Same here. It's been a LONG time since we had an HMO, but finding out after the fact that our primary care physician was supposed to approve even an ER visit was an unpleasant surprise. (This was in 1993.)

 

I like the freedom of the PPO. I can take my kid to any doctor anywhere, anytime, and the most we might have to pay would be 20% (for an out-of-network doctor) after the deductible.

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We have had a PPO for at least 8 years now, and if we didn't, I would not have had the quality of care I need for my ongoing medical conditions. I am able to choose my Drs and it makes ALL the difference. I have friends on HMOs who have cancer. They see who they're told to see, there is NO choice whatsoever. PPOs may cost more out of pocket during the medical treatments, but the peace of mind is worth it.

 

Blessings!

Dorinda

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It, of course, is a personal matter, but I would prefer a PPO over an HMO. The extra money I pay for the the peace of mind that comes with a PPO is worth it to me. I really, really dislike HMO plans! Now, if the extra cost of a PPO plan would mean I could get NO medical care then I would go with the HMO. I figure some care is better than no care.

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Wanted to add that you need to know if the doctors on the HMO are taking new patients. That was a huge issue for us. Even though we had "chosen" a doctor with our HMO, because we didn't visit the doctor until we needed to go, that practice was closed to new HMO patients. It turned out that the only PCP's on the plan that still took patients only did so because no one else wanted them.

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We have always had a PPO - since so many of us have oddball ailments and need to see specialists a PPO makes more sense. This year along we have used:

surgeon, two neurologists, pediatrician, urologist, orthodontist, three different orthopedists (one who did wrist surgery, too), eye doc., oral surgeon, physical therapist, and pain specialist. Blood draws, MRI's, SPEC scans, bone scans, x-rays, ultrasounds, root canals and doppler thingies. And something that involved teeny tiny needles and electrical impulses (ENT? EMT? E-something). Three of us are on daily meds that some three-months at a time from insurance-paid mail order. Gall bladders, wisdom teeth, ganglion cysts and cataracts have been removed (not all from the same person, thank heavens!).

 

If I had to get permission from an HMO to do all this I would go mad.

 

Rereading this - it looks like we are falling apart here!

Edited by JFSinIL
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We had a HMO for 30 years and loved it. But it was a ginormous HMO---Kaiser Permanente--that had its own hospitals and everything. We had a single co-pay for every visit, no matter what it was. When Mr. Ellie had a heart attack and subsquent quadruple by-pass, we didn't pay a penny, even though he was transferred to an "outside" hospital because Kaiser didn't have the cardiac specialists he needed.

 

There was no HMO offered when we moved to Texas, so we've had "regular" health insurance. I don't think it's a PPO. :confused: Even so, we've had a co-pay for doctor visits, never a bill in the mail, except for 1 incident (thought it was a heart attack, 911 call, ambulance,the whole thing. No, it wasn't.:)) We paid a deductable; the rest was covered.

 

So if I could find a HMO like Kaiser, I'd take it in a heartbeat. Loved it. My second choice would be the PPO. My third would be...whatever's left. :-)

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Guest Cheryl in SoCal

It really depends on the plan and the family's needs. We currently have an HMO and wouldn't change to a PPO with our current circumstances. Our children's medical group is part of the large children's hospital that we want to go to when they need specialized treatment. Because they are one in the same we don't need referrals to ANY of the specialists or authorization for ANY of their surgeries. This is HUGE, especially when you have 2 children with major special needs. One daughter has had well over $300,000 worth of surgeries on her eyes for glaucoma and we paid NOTHING, and since we didn't need referrals or authorizations and were seeing the doctors we wanted to see everything was always fast and care excellent! My other dd's cleft surgeries and ear tubes (probably totaling over $150,000 but I eventually stopped counting) also cost us nothing. If we had a PPO instead of an HMO we would be BROKE! I really don't know how we would have afforded the medical care our children need.

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I have always chosen a PPO because I wanted a choice in which doctors I see. Unfortunately, what is happening with our health insurance is that they are raising the deductible so high on out-of-network providers and then paying a lower and lower percentage even if you do reach the deductible, that what we have, in essence, is an HMO.

 

My primary care doctor is out-of-network and I have a chronic illness, so I see him often, but my insurance never pays a dime anymore because the deductible is so high.

 

So, at this point, if my husband's company offerred an HMO as an option (and it was cheaper), I would go in that direction since I am paying out of pocket for anyone I want to see out-of-network anyway.

 

Lisa

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Dh wants to try the HMO plan. It sounds like what we need, since we only see the Dr..every blue moon.

The premiums are cheaper than the PPO, lower deductible and the Dr's are only a couple of miles further. We have to pay out-of-pocket for everything we do with the PPO plan, due to extremely high deductibles. So, to pay a co-pay when we go to the Dr. sounds wonderful. Also, to be able to take the kids to a well-visit and get their immunization for $20 sounds wonderful! Our PPO doesn't even pay for immunization or well-visits!

If we find that we don't like it, then we can switch next year.

 

Thanks everyone for your feedback!

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Like I mentioned before, I would verify that those docs are still taking new patients (call their offices.) Then, in order to be considered a patient, get in there. If you don't have a file in their office, you won't be considered a patient by that doctor (even if you choose that doc as your pcp.) If you wait until you need a doctor, you may find that you have to drive much further (or are stuck with someone terribly incompetent.)

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Dh wants to try the HMO plan. It sounds like what we need, since we only see the Dr..every blue moon.

The premiums are cheaper than the PPO, lower deductible and the Dr's are only a couple of miles further. We have to pay out-of-pocket for everything we do with the PPO plan, due to extremely high deductibles. So, to pay a co-pay when we go to the Dr. sounds wonderful. Also, to be able to take the kids to a well-visit and get their immunization for $20 sounds wonderful! Our PPO doesn't even pay for immunization or well-visits!

If we find that we don't like it, then we can switch next year.

 

Thanks everyone for your feedback!

 

That's a bad PPO!!!! I would have looked into the HMO too. Here, the HMOs are more expensive per month and the PPO has a better premium.

 

Sounds like a good decision considering your situation!

Blessings!

Dorinda

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My parents have belonged to a doctor-owned co-op HMO for decades and they've always been happy with it. They've fortunately never have had any serious health issues and like their primary care doctor.

 

After having such an awful experience with military insurance, we've always chosen a PPO. However, next year depending on our circumstances, we may need to switch to Kaiser HMO.

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